Exam 4 (US & CVL)

Question 1

What are the contraindications for a CVL?

Answer 1

• Renal cell tumor extending into the right atrium
• Tricuspid valve regurgitation
• Site infection
• Site specific

Question 2

What are the possible complications of a CVL?

Answer 2

• Pneumo/Hemothorax
• Line-related infections
• Carotid puncture
• Dysrhythmias
• Trauma to nearby nerves

Question 3

What position is preferred for placing a CVL and why?

Answer 3

• Trendelenburg
• To decrease risk of air embolism & increase venous return

Question 4

What area is prepped for a CVL?

Answer 4

Chin-sternum-shoulder-neck area

Question 5

How is the CVL wire inserted?

Answer 5

• In a twisting motion thru the vein needle
• Always hold on to the wire

Question 6

What are the approximate distances for right SC & IJ CVLs?

Answer 6

• IJ is 15 cm
• SC is 14 cm

Question 7

What are the approximate distances for left SC & IJ CVLs?

Answer 7

• IJ is 18 cm
• SC is 17 cm

Question 8

What are the advantages for ultrasounds?

Answer 8

• Identify anatomical structures
• Relationship of needle to tissues
• May decrease time
• May decrease complications

Question 9

US waves travel at what hertz?

Answer 9

2 - 20 MHz

Question 10

What structures transmit US waves?

Answer 10

• Fluid
• Anaechoic areas

Question 11

What structures reflect US waves?

Answer 11

• Bones/stones
• Hyperechoic areas

Question 12

What frequency do Linear arrays operate in?

Answer 12

7 - 15 MHz

Question 13

What frequency do Curved arrays operate in?

Answer 13

2 - 5 MHz

Question 14

What frequency do Phased arrays operate in?

Answer 14

1 - 3 MHz

Question 15

Phased arrays are good for?

Answer 15

Echocardiography

Question 16

What is accomplished in static US approach?

Answer 16

• Identifying target vessels
• Assessing patency
• Marking an appropriate insertion site

Question 17

How do you hold the transducer probe?

Answer 17

Like a pencil

Question 18

US gain adjusts what?

Answer 18

Quality of the signal coming back to transducer (brightness)

Question 19

You adjust gain until the fluid is ____ & soft tissue is ___?

Answer 19

• black
• mid-grey

Question 20

US depth is shown in ____.

Answer 20

centimeters

Question 21

The axis of a US technique refers to?

Answer 21

The vessel

Question 22

What axis should one be in for a procedure?

Answer 22

In-plane or long axis

Question 23

What is the advantage & disadvantage of in-plane?

Answer 23

• Advantage of seeing the needle & tip
• Disadvantage to easily be off plane

Question 24

What is the advantage & disadvantage of out-of-plane?

Answer 24

• Advantage: Needle is positioned directly under the US plane
• Disadvantage: Unclear where the tip of the needle is

Question 25

What is the vanishing sign used for?

Answer 25

Determine wether the needle or wire is in the lumen as it moves. Look for bright (hyperechoic)

Question 26

What are the indications for using FAST?

Answer 26

To rule out free fluid/blood in the abdomen or the pericardium on a trauma Pt

Question 27

What are the 4 assessment points for FAST?

Answer 27

- RUQ- Morison's pouch - LUQ- Peri-splenic view - Pelvic view- Suprapubic - Cardiac view

Question 28

Where is the Morison's pouch located?

Answer 28

Between the liver & right kidney

Question 29

What can Heeling and/or Toeing help with?

Answer 29

To maintain parallell alignment

Question 30

What is the "pop" you feel during an US nerve block?

Answer 30

Entering the fascia

Question 31

What are the indications for gastric US?

Answer 31

- Lack of adherence to fasting instructions - Unclear fasting history - Potential delay in gastric emptying

Question 32

What will a normal stomach US image look like?

Answer 32

Like a bullseye

Question 33

What does a grade 1 Antrum mean?

Answer 33

- The stomach contents are < 1.5mL/kg - The Pt is unlikely to aspirate

Question 34

What does a grade 2 Antrum mean & how do you proceed?

Answer 34

- The Pt's stomach contains >1.5 mL/kg of fluid or solid food - Pt is at risk for aspiration - RSI or postpone Sx