Procedures

Question 1

You have failed to put in a subclavian line on the right. What must you do before attempting on the left?

Answer 1

CXR to exclude pneumthorax

def don’t want a bilateral pneumothorax

Question 2

What is the landmark for blind infraclavicular approach subclavian central line?

Answer 2

Junction of middle and medial third of clavicle

Question 3

What is the “V” technique for finding the femoral vein landmark during pulseless cardiac arrest?

Answer 3

Thumb on pubic tubercle and index finger on ASIS. Vein is at V made by thumb and index finger

Question 4

What are contraindications to IO access?

Answer 4

• ipsilateral fracture
• severe osteoporosis or osteogenesis imperfect

Question 5

What are complications of IO access?

Answer 5

• osteomyelitis
• cellulitis
• iatrogenic fracture
• physeal plate injury
• fat embolism (rare)
• compartment syndrome/extravasation if disloded
• pain in awake pt

Question 7

What are complications of central line insertion?

Answer 7

• arterial puncture
• chylothorax (left subclavian or left IJ)
• pneumothoroax (IJ or subclavian)
• catheter associated infection
• thrombosis
• hydrothorax/hydromediastinum (infusion into pleural space)
• air emboli
• great vessel or right atrial perforation (haemothorax, tamponade)
• airway compromise (tracheal injury, haematoma causing airway compromise)

Question 8

What are the locations for IO access?

Answer 8

• proximal tibia: 2cm below tuberosity and on medial flat surface
• medial malleolus: identify malleolus then move proxiam 2-3cm
• distal femur: 1cm proxial to patella and 1-2cm medial
• proximal humerus: internally rotate pts arm, hand planced on abdomen, palpate greater tuberisty anteriorly

Question 9

What are complications of an arterial line

Answer 9

• pain
• haematoma
• haemorrhage
• artery laceration/injury
• artery vasospasm
• pseudoaneurysm
• arteriovenous fistula
• infection
• limb ischaemia
• thrombosis/ embolism
• nerve damage/neuropathy