Surgery - Vascular Catheterisation

Question 1

What are the indications for the insertion of a central venous catheter?

Answer 1

Critically ill pts requiring continuous CVP monitoring
Infusion of irritant substances
Precise infusion of substances w/ narrow therapeutic window
Long-term access for parenteral nutrition/chemo/a-b
Haemodialysis
No other venous access

Question 2

What are the common types of central venous catheter?

Answer 2

Hickman
PICC
Portacath

Question 3

Describe a Hickman line

Answer 3

Tunnelled beneath skin for stability/prevent infection

Usually inserted into IJV on RHS

Question 4

Describe a PICC line

Answer 4

Peripherally inserted central catheter

Inserted into arm and advanced to SVC

Question 5

Describe a Portacath

Answer 5

Port installed beneath skin and connected to a vein by a catheter

Question 6

What are the potential complications of a central venous catheter?

Answer 6

Haemorrhage/arterial puncture
Pneumothorax
Thoracic duct drainage
Air embolism
Thrombosis
Catheter-related sepsis

Question 7

What is a Swan-Ganz catheter?

Answer 7

Balloon catheter passed from femoral vv to pulmonary artery to measure pressure
-can also be advances to ‘wedge’ small pulmonary vessel

Question 8

What are the indications for the insertion of a Swan-Ganz catheter?

Answer 8

Assessment of haemodynamic response to therapies (ITU)
Monitoring of complicated MI/post cardiac surgery
Diagnosis of high vs low pressure pulmonary oedema
Diagnosis of idiopathic pulmonary HTN/PE

Question 9

What are the potential complications of a Swan-Ganz catheter?

Answer 9

Arrhythmias
Valve trauma
Pulmonary infarction/pulmonary artery rupture

Question 10

What are the indications for arterial catheterisation?

Answer 10

Frequent blood sampling/ABG analysis

Continuous invasive BP monitoring

Question 11

Where are arterial catheters typically inserted?

Answer 11

Radial artery

Question 12

What is Allen’s test?

Answer 12

Test of ulnar collateral, performed prior to arterial sampling

• elevate hand, ask pt to make a fist while occluding radial & ulnar (30secs)
• ask pt to open hand (should be blanched)
• release ulnar pressure (colour returns <7secs)

Question 13

What are the potential complications of arterial catheters?

Answer 13

Digital ischaemia
Thrombosis
Haemorrhage

Question 14

What factors are key when caring for central venous lines?

Answer 14

Report signs of infection/bleeding
Do not get site wet
Avoid contact sports