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Flashcards in Great Vessels Deck (11):
1

AORTA
Ascending Aorta
- ______________
Arch of Aorta
- ___________
- ___________
- ___________
Descending Artery
- bronchial, mediastinal, esophageal, posterior intercostal, pericardial, subcostal
Abdominal Aorta

AORTA
Ascending Aorta
- R and L coronaries
Arch of Aorta
- brachiocephalic
- L common carotid artery
- L subclavian
Descending Artery
- bronchial, mediastinal, esophageal, posterior intercostal, pericardial, subcostal
Abdominal Aorta

2

The common carotid bifurcates at the vertebral level _____.

C4

3

Aneurysm of the Aortic Arch
- pulsatille swelling in the __________

suprasternal notch

4

COARCTATION OF THE AORTA
- occurs twice as often in _______ than females
- blood pressure is __________ in the lower limbs and __________ in the head, neck, and upper limbs
- anastomoses in the intercostal spaces between the anterior intercostal (from internal thoracic) and posterior intercostal (from descending aorta); dilation of the intercostal arteries may result in resorption of ribs and notching seen on x-rays

Preductal Coarctation
- constriction is __________ to the ductus arteriosus; prognosis is _______; infantile form of coarctation

Postductal Coarctation
- constriction is ________ to the ductus arteriosus; most common form; adult form of coarctation

COARCTATION OF THE AORTA
- occurs twice as often in males than females (Arc Sheen is a male)
- blood pressure is reduced in the lower limbs and elevated in the head, neck, and upper limbs
- anastomoses in the intercostal spaces between the anterior intercostal (from internal thoracic) and posterior intercostal (from descending aorta); dilation of the intercostal arteries may result in resorption of ribs and notching seen on x-rays

Preductal Coarctation
- constriction is proximal to the ductus arteriosus; prognosis is poor; infantile form of coarctation

Postductal Coarctation
- constriction is distal to the ductus arteriosus; most common form; adult form of coarctation

5

INTERNAL JUGULAR VEIN
- continuation of the ____________
- leaves the skull through the _____________
- descends through the neck in the _________ sheath ________ to the vagus nerve and internal and common carotid arteries
- closely related to the ____________ lymph nodes

INTERNAL JUGULAR VEIN
- continuation of the sigmoid sinus
- leaves the skull through the jugular foramen
- descends through the neck in the carotid sheath lateral to the vagus nerve and internal and common carotid arteries
- closely related to the deep cervical lymph nodes

6

Common sites for central venous catheterization: (3)

Internal jugular vein
Subclavian vein
Femoral vein

7

SUBCLAVIAN CATHETERIZATION -- Infraclavicular Approach
- Subclavian vein lies close to the undersurface of the ________ third of the clavicle
- After sterile preparation and draping of the patient, local anesthetic is infiltrated subcutaneously 3 cm ________ to the midpoint of clavicle
- Place index finger at sternal notch and thumb at intersection of clavicle and ______ rib; needle is inserted below the clavicle and _______ to thumb on R side (needle is inserted along the inferior edge of the clavicle 2-4 cm ________ to its midpoint; advanced towards the sternal notch). Gentle aspiration is applied until dark, nonpulsatile venous blood is evident.
- Needle pierces the following structures:
---- skin, superficial fascia, _____________ (clavicular head), clavipectoral fascia, ____________ muscle, wall of subclavian vein

SUBCLAVIAN CATHETERIZATION -- Infraclavicular Approach
- Subclavian vein lies close to the undersurface of the medial third of the clavicle
- After sterile preparation and draping of the patient, local anesthetic is infiltrated subcutaneously 3 cm lateral to the midpoint of clavicle
- Place index finger at sternal notch and thumb at intersection of clavicle and first rib; needle is inserted below the clavicle and lateral to thumb on R side (needle is inserted along the inferior edge of the clavicle 2-4 cm lateral to its midpoint; advanced towards the sternal notch). Gentle aspiration is applied until dark, nonpulsatile venous blood is evident.
- Needle pierces the following structures:
---- skin, superficial fascia, pectoralis major (clavicular head), clavipectoral fascia, subclavius muscle, wall of subclavian vein

8

INTERNAL JUGULAR VEIN CATHETERIZATION
- Patient is placed in a Trendelenburg position
- Head is turned to the ______ because:
---- it flattens the IJV
---- it stretches the SCM and accentuates the lesser supraclavicular fossa
---- the pulse of the CCA is more easily palpated in the apex of the fossa
- After sterile preparation and draping of the patient, local anesthetic is infiltrated subcutaneously into the ________ supraclavicular fossa.
- Needle is inserted at the ______ of the lesser supraclavicular fossa or the triangle formed by the heads of SCM and clavicle on the R side.
- Gentle aspiration during needle insertion is applied until dark, nonpulsatile venous blood is evident.
KEY ANATOMIC RELATIONSHIPS:
- the position of the carotid sheath in the ______ supraclavicular fossa
- the position within the carotid sheath (IJV is _______ to the common carotid artery)

INTERNAL JUGULAR VEIN CATHETERIZATION
- Patient is placed in a Trendelenburg position
- Head is turned to the left because:
---- it flattens the IJV
---- it stretches the SCM and accentuates the lesser supraclavicular fossa
---- the pulse of the CCA is more easily palpated in the apex of the fossa
- After sterile preparation and draping of the patient, local anesthetic is infiltrated subcutaneously into the lesser supraclavicular fossa.
- Needle is inserted at the apex of the lesser supraclavicular fossa or the triangle formed by the heads of SCM and clavicle on the R side
- Gentle aspiration during needle insertion is applied until dark, nonpulsatile venous blood is evident.
KEY ANATOMIC RELATIONSHIPS:
- the position of the carotid sheath in the lesser supraclavicular fossa
- the position within the carotid sheath (IJV is lateral to the common carotid artery)

9

BRACHIOCEPHALIC VEIN
- union of the _______________ vein and the _______________ vein
- At the level of the ________ border of the _________ R costal cartilage, the R and L unite to form the ________

BRACHIOCEPHALIC VEIN
- union of the internal jugular vein and the subclavian vein
- At the level of the inferior border of the first R costal cartilage, the R and L unite to form SVC

10

SUPERIOR VENA CAVA
- union of the R and L ____________ veins
- ends at the level of the ____ R costal cartilage to enter the R atrium
SUPERIOR VENA CAVA SYNDROME
- The SVC may be compressed by lymph node enlargement because of metastasis from a _____________ carcinoma
- may experience headache, edema of the head and neck, superficial veins, and cyanosis
- if obstructed, venous blood causes distention of the veins running from the anterior chest wall to the thigh; lateral thoracic vein anastomoses with the ___________________ vein
- In a complete occlusion, venous return from the head, neck, and upper limbs is shunted into the tributaries of the IVC

SUPERIOR VENA CAVA
- union of the R and L brachiocephalic veins
- ends at the level of the 3rd R costal cartilage to enter the R atrium
SUPERIOR VENA CAVA SYNDROME
- The SVC may be compressed by lymph node enlargement because of metastasis from a bronchogenic carcinoma
- may experience headache, edema of the head and neck, superficial veins, and cyanosis
- if obstructed, venous blood causes distention of the veins running from the anterior chest wall to the thigh; lateral thoracic vein anastomose with the superficial epigastric vein
- In a complete occlusion, venous return from the head, neck, and upper limbs is shunted into the tributaries of the IVC

11

AZYGOS VEIN
- connects _______ and _______
- formed by the union of R _____________ and R _____________ veins
- ascends through the ________ opening in the diaphragm on the R side of the aorta to the level of the ____ vertebra

AZYGOS VEIN
- connects SVC and IVC
- formed by the union of R ascending lumbar and R subcostal veins
- ascends through the aortic opening in the diaphragm on the R side of the aorta to the level of the T5 vertebra