Peripheral and Central Access, Hemodynamic Monitoring

Question 1

Which site is considered optimal for insertion of an intraosseous line?

Answer 1

Proximal tibia

Question 2

Syringes smaller than ____ mL should not be used for hemodialysis shunts in order to prevent catheter damage from excess infusion pressure.

Answer 2

10

Question 3

All medications should be flushed with ___ mL of saline to avoid clots.

Answer 3

5

Question 4

T/F: The non-tunneled catheters are designed for short-term or intermediate-term access.

Answer 4

True

Question 5

T/F: Peripherally inserted central catheters are designed for intermediate-term to long-term venous access.

Answer 5

True

Question 6

A power PICC can accommodate pressures up to ____ PSI.

Answer 6

300

Question 7

Which of the following is TRUE regarding tunneled catheters?
a) They are constructed of a thin-walled silicone
b) They cannot withstand high pressures (such as dialysis)
c) They can be single, double, or triple lumen large bore catheters
d) They are designed for short-term to intermediate-term use

Answer 7

c) They can be single, double, or triple lumen large bore catheters

Question 8

SVADs require a special injection non-coring needle called:

Answer 8

Huber needle

Question 9

T/F: If a Huber needle is not available, a 22ga butterfly needle can be used to access a SVAD port.

Answer 9

False

Question 10

T/F: If a CVAD is infusing sluggishly, it should be vigorously infused with 20-30 mL of normal saline.

Answer 10

True

Question 11

T/F: Arterial lines provide systolic and diastolic pressure immediately and are more accurate than traditional noninvasive techniques.

Answer 11

True

Question 12

What artery is easiest to cannulate for an arterial line?

Answer 12

Femoral artery due to its size

Question 13

Arterial lines should always be labeled in what color to prevent accidental medication administration?

Answer 13

Red

Question 14

For an arterial line, the ____ mL bag of normal saline should always be pressurized to ____ mmHg to prevent backflow into the cannula and tubing.

Answer 14

500, 300

Question 15

Arterial lines typically provide ___ga access to adults.

Answer 15

20

Question 16

T/F: A dampened arterial waveform typically overestimates blood pressure.

Answer 16

False, a dampened arterial waveform typically underestimates blood pressure.

Question 17

What is typically the reason an arterial waveform is dampened?

Answer 17

Over-pressurization of the pressure bag

Question 18

The typical arterial line transducer will need to be changed every ____ hours.

Answer 18

96

Question 19

Which of the following is the most important reason to ensure that the arterial line flush bag does not run dry?

Answer 19

Prevention of an air embolus

Question 20

T/F: If an arterial line monitor is not producing waveform, you should ensure that all the clamps are open.

Answer 20

True

Question 21

T/F: If the transducer is placed too low, the readings will be falsely high.

Answer 21

True

Question 22

T/F: If the arterial line waveform is lost, catheter patency can be checked by attaching a 3cc syringe to the stopcock and withdrawing blood.

Answer 22

True

Question 23

In the event of accidental dislodgment of an arterial line, pressure should be maintained over the site for a minimum of _____ minutes.

Answer 23

5

Question 24

What is the most important information obtained from hemodynamic monitoring?

Answer 24

Stroke volume

Question 25

What color is the proximal lumen that measures central venous pressure?

Answer 25

blue

Question 26

What sized syringe should be used to inflate the pulmonary artery ballooon?

Answer 26

1.5cc

Question 27

The pulmonary artery catheter must always maintain a constant flow of ______ in order to maintain patency of the line.

Answer 27

3-5cc/hr

Question 28

What must the transducer be level with in order to read accurately?

Answer 28

The right atrium

Question 29

What are the typical indications for leveling of the transducer?

Answer 29

- Upon insertion - Upon change in the patient's position - Just prior to taking a reading

Question 30

What is the normal range of CVP and RAP?

Answer 30

2 - 6 mmHg

Question 31

What is a common cause of an elevated CVP and RAP?

Answer 31

Pulmonary Hypertension

Question 32

T/F: Right ventricular pressure can only be measured during insertion.

Answer 32

True

Question 33

The pulmonary artery pressure is the pressure within the pulmonary artery when the balloon is ________.

Answer 33

deflated

Question 34

The pulmonary artery balloon should be inflated for no longer than _____ seconds.

Answer 34

15

Question 35

T/F: After wedging, the balloon is allowed to passively deflate and return to the right ventricle.

Answer 35

False

Question 36

What is the normal range for wedge pressures?

Answer 36

4 - 12 mmHg

Question 37

Which of the following patients would typically have a low cardiac output? a) patient with hyperthyroidism b) patient that was just administered vasopressin c) patient with anemia d) patient with a heart rate of 168

Answer 37

d) patient with a heart rate of 168

Question 38

T/F: Right ventricular preload is the same as central venous pressure (2 - 6 mmHg).

Answer 38

True

Question 39

T/F: The left ventricular preload (LVP) can be indirectly measured by the wedge pressure, and is the same as the left ventricular end diastolic pressure (LVEDP).

Answer 39

True

Question 40

Your patient has a pulmonary artery catheter inserted. You are now seeing runs of ventricular tachycardia. What should you suspect first?

Answer 40

The right ventricular endocardium is being irritated by the catheter tip.

Question 41

You note spontaneous wedging. What are acceptable actions to take?

Answer 41

- Try turning the patient on their side - Aspirate for blood return - Have the patient raise their arm (nearest to the catheter) above their head and cough

Question 42

Your patient has a pulmonary artery catheter inserted. What action should be taken if you witness a dampened waveform?

Answer 42

This can be fixed by attempting to pull the catheter back into the right atrium.