Vascular Access*

Question 1

what is the purpose of IV placement?

Answer 1

NPO “non per os”
Fluid Loss
Blood Loss
Drug Administration

Question 2

plasma volume is approx. what?

Answer 2

~2 L

Question 3

what percentage of water is intracellular vs. extracellular?

Answer 3

intracellular = 65%
extracellular = 35%

Question 4

osmolality

Answer 4

the concentration of an osmotic solution per 1000 grams of solvent

Question 5

osmolarity

Answer 5

the concentration of osmotic solution per liter of fluid

Question 6

normal OSMotic pressure

Answer 6

Normal = 285 mOsm/L

Question 7

normal ONCotic pressure

Answer 7

Oncotic pressure (mmHg) 
Normal = 28 mmHg

Question 8

Frequently used in place of osmotic pressure or tension, is related to the number of non-penetrating particles found in solution

Answer 8

tonicity

Question 9

Of equal tension. Denoting a solution having the same tonicity as another solution with which it is compared

Answer 9

isotonic

Question 10

Having a higher concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells shrink due to efflux of water.

Answer 10

hypertonic

Question 11

Having a lower concentration of solute particles per unit volume than a comparison solution, regardless of kinds of particles. A solution in which cells expand due to influx of water.

Answer 11

hypotonic

Question 12

what happens to a RC in a hyper-, hypo-, and isotonic solution?

Answer 12

hypertonic = shrinks
hypotonic = swells
isotonic = nothing

Question 13

what are the normal plasma values for Na+ and K+?

Answer 13

135-145

3.5-5.0

Question 14

which commonly given fluid contains Ca2+ and why does that matter?

Answer 14

LR

Ca2+ can start the coagulation cascade

Question 15

what dictates whether the solution should be delivered via the peripheral or central venous route?

Answer 15

The tonicity of an IV fluid
Extremely hypotonic and hypertonic solutions may be infused in small volumes and into large vessels, where dilution and distribution are rapid.

Question 16

The generally accepted upper limit for a peripheral IV is ______ mOsm/L

Answer 16

900

Question 17

T or F: K+ can be given peripherally

Answer 17

FALSE

Question 18

in normal adults, what is the average daily fluid loss?

Answer 18

Total ~2500 ml/day

Question 19

4-2-1 Rule

Answer 19

Example: 70kg pt
4ml/kg/hr*10kg = 40 ml/hr
2ml/kg/hr*10kg = 20 ml/hr
1ml/kg/hr*50kg = 50 ml/hr
		       	70kg = 110 ml/hr

Question 20

what is the Sensible Fluid Loss Perioperative for minor, moderate and major surgery?

Answer 20

2-4 ml/kg/hr minor surgery (hernia)
4-6 ml/kg/hr moderate surgery (chole)
6-10 ml/kg/hr major surgery (bowel resection)

Question 21

Replace 1mL blood loss with ___mL crystalloid or ___mL colloid

Answer 21

3

1

Question 22

Monitor vitals and maintain urine output at a MINIMUM _____ml/kg/hr

Answer 22

0.5

Question 23

fluid calculation

Answer 23

Hysterectomy 70 kg Female
NPO Deficit 10 hrs = 1100 ml NS
Maintenance 110 ml/hr
Blood loss = 300 = 900 ml NS
Sensible loss 4 ml/kg/hr = 280 ml/hr
Total case 3 hours = 1100+330+900+840 = 3170 ml

Question 24

how much blood can a 4x4 and lap pad hold?

Answer 24

Surgical sponge (4x4)
10mL blood
“Lap pads”
100-150mL blood

Question 25

Aqueous solution of low MW ions with or without glucose | Examples: NS, Lactated Ringers, Plasma-Lyte

Answer 25

crystalloid

Question 26

Aqueous solution of high MW substances Maintain plasma colloid oncotic pressure Albumin, Hetastarch, etc.

Answer 26

colloid

Question 27

Intravascular halflife of crystalloids is

Answer 27

20-30min

Question 28

advantages/disadvantages of crystalloids and colloids

Answer 28

CHART

Question 29

A potential complication of giving too much Normal saline is what?

Answer 29

Hypochloremic metabolic acidosis

Question 30

which fluid can lower Na levels?

Answer 30

LR

Question 31

when would you give 3% and 7.5% NaCl?

Answer 31

Severe hyponatremia or hypovolemic shock

Question 32

how much fluid should be given in the first hour?

Answer 32

half of NPO deficit + maintenance

Question 33

what are some potential side effects of dextran?

Answer 33

coagulopathy, renal dysfunction, anaphylaxis, osmotic diuresis

Question 34

what is normovolemic hemodilution?

Answer 34

take blood out of pt before a case and give it back at the end

Question 35

how do you calculate EBL?

Answer 35

[(Hcti-Hcta) / Hct avg] x EBV = ABL

Question 36

For each unit of PRBC transfused you can expect the HCT to increase by ___% or Hgb to increase by ____ g/dl

Answer 36

3% | 1

Question 37

transfusion is rarely indicated when the hemoglobin concentration is greater than ____ g/dL and is almost always indicated when it is less than ___ g/dL, especially when anemia is acute

Answer 37

10 | 6

Question 38

when and how would you administer PRBC?

Answer 38

Admin pt. who require RBC but no volume Carefully checked against blood slip and patient ID Transfusion w/170 micron filter Blood warmed prior to infusion

Question 39

when is the Rh system particularly important?

Answer 39

in childbearing women, can cause reactivity between mom and baby

Question 40

which blood compatability test is more sensitive and which test is for antibodies?

Answer 40

type and cross = sensitive | type and screen = antibodies

Question 41

what is the universal donor?

Answer 41

O-

Question 42

what blood product do you not warm?

Answer 42

platelets

Question 43

when is a platelet transfusion recommended?

Answer 43

Plt < 50k increase Sx blood loss Oncology Pt >10,000/mm3 Target > 100k/mm3 Each unit increases 5-10k/mm3

Question 44

which transfusion product is associated with hemophelia pts?

Answer 44

Cryopercipitate

Question 45

what blood product are you most likely to see a reaction/complication from and why?

Answer 45

platelets---multidonor

Question 46

what is the most common non-infectious reaction to blood products?

Answer 46

fever

Question 47

what do AHTR and TRALI stand for?

Answer 47

Acute Hemolytic Transfusion Reaction Transfusion Related Acute Lung Injury

Question 48

three most common site for arterial cannulation?

Answer 48

radial femoral brachial

Question 49

what does Allen's test check for?

Answer 49

collateral circulation

Question 50

what sites are contraindicated in patients with Raynaud’s Syndrome for art lines?

Answer 50

radial and ulnar

Question 51

what is Raynaud's syndrome?

Answer 51

constriction of vessels decreases blood supply to the fingers

Question 52

which artery is prone to pseudoaneurysm and atheroma formation as documented following cardiac catheterization. It also has an increased incidence of infection.

Answer 52

femoral

Question 53

when would you need to gain central venous access?

Answer 53

``` Monitoring central venous pressure Fluid administration Infusion of caustic Rx TPN (total parenteral nutrition) Air emboli aspiration Transcutaneous pacing leads Poor peripheral access ```

Question 54

what are some contraindications for central venous access?

Answer 54

R atrial tumors Fungating tricuspid valve vegetations Contraindications relative to site: Local sepsis Previous vessel damage Suspected injury to IVC or SVC

Question 55

What are some common sites for central venous access?

Answer 55

Femoral vein External jugular Internal jugular* Subclavian vein

Question 56

what is Seldinger’s Technque?

Answer 56

when you thread a catheter over a wire

Question 57

potential complications from central venous access

Answer 57

``` Pneumothorax/hemothorax   Air embolism Arrhythmias Carotid artery puncture/cannulation Infection** ```

Question 58

when you see a sudden dramatic increase in lactate, this would indicate what?

Answer 58

anaerobic metabolism