Vascular Access P2

Question 1

Lactated ringers are ____ and raise/lower Na levels.

Answer 1

hypotonic

lower

Question 2

NS is ___%.

Does not contain ___.

Causes ____ _____ _____.

Answer 2

0.9

potassium

HYPOchloremic metabolic acidosis

Question 3

What are D5W and D5NS good to replace?

Answer 3

pure H2O deficit

Question 4

3% and 7.5 NaCL are extremely _____.

Cause severe _____ or _____ ____.

Answer 4

hypertonic

• hyponatremia
• hyovolemic shock

Question 5

Examples of colloids (3):

Answer 5

• albumin
• dextran
• hetastarch

Question 6

What fluid is often used for reattaching fingers, for example?

Why?

Answer 6

Dextran

We don’t want to vasoconstrict vessels by using phenylephedrine and keeps the vessels slippery. It also prevents clots from forming.

Question 7

This colloid may cause hypocalcemia allergic reactions and impaired lung function

Answer 7

albumin

Question 8

This colloid may cause hypotension.

Answer 8

albumin

Question 9

This colloid may cause coagulopathy, renal dysfunction, anaphylaxis, and osmotic diuresis.

Answer 9

dextran

Question 10

May cause coagulopathy and anaphylactoid reactions

Answer 10

hetastarch

Question 11

Half life of hetastarch is ____ hours

Answer 11

25.5

Question 12

What may be associated with increased bleeding, may prolong PT, aPTT, bleeding?

Prolong PT, bleeding if > ___ ml/kg

Answer 12

Hetastarch

Hextend

Hextend MW ≈ 670

20

Question 13

Types of blood products: (6)

Answer 13

• PRBC
• FFP
• Cryoprecipitate
• platelets
• cell saver
• whole blood (we deliver in this form)

Question 14

Transfusion triggers of when to give blood:

Answer 14

• acute/chronic anemia
• level of oxygen
• evidence of impaired oxygen carrying capacity
• rate/magnitude of blood loss

Question 15

Estimate blood volume:

women: ___ ml/kg
men: ___ ml/kg
infants: ___ ml/kg

Answer 15

60

70

80

Question 16

For each unit of PRBC transfused you can expect HCT to increase by ___% or Hgb to increase by ___gram/dL

Answer 16

3

1

Question 17

Transfusion of PRBC 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 the anemia is acute.

Answer 17

10

6

Question 18

Administer PRBC to patient who require RBC but no volume.

Transfuse with ___ micron filter.

Always to remember to do this before infusion:

Answer 18

170

warm blood

Question 19

Give this type of blood to childbearing age women when in a hurry.

Answer 19

O-

Question 20

What is important in childbearing women

Answer 20

Rh system

Question 21

What compatability test confirms ABO and Rh type and detects other antibodies?

Answer 21

Type and cross

Question 22

What compatability tests for top 100 antibodies?

Answer 22

type and screen

Question 23

Platelets < ____ increase Sx blood loss

Answer 23

50k

Question 24

Each unit of platelets increases ___-___ k/mm³

Answer 24

5-10k

Question 25

Platelets pooled from \_\_\_-\_\_\_ donors

Answer 25

6-8

Question 26

Warm platelets before transfusing. True or false?

Answer 26

false

Question 27

Contains all plasma proteins and factors II, V, VII, IX, X, XI and AT III

Answer 27

Fresh frozen plasma

Question 28

Each unit increases clotting factors \_\_\_-\_\_\_%

Answer 28

2-3

Question 29

FFB have same infectious risk as PRBC. True or false?

Answer 29

true

Question 30

Cryroprecipritate and FFP need to be ABO typed. True or false.

Answer 30

False

Question 31

What factors does cryroprecipitate have? (4)

Answer 31

8 13 von Willebrand factor FIBRINOGEN

Question 32

Transfusion related Hep B risk

Answer 32

1/350k

Question 33

Transfusion related Hep C and HIV risk

Answer 33

1 / 2million

Question 34

Transfusion related febrile reaction risk:

Answer 34

1/200

Question 35

Transfusion related anaphylactic risk:

Answer 35

1/25 - 50k

Question 36

Ideal site for arterial cannulation

Answer 36

* easy access * relatively superficial vessel * non-torturous vessel * collateral circulation distal to the site of cannulation * migration of thrombogenic material will have minimal impact

Question 37

Test for collateral circulation (3)

Answer 37

* Allen's test (5-10 second refill) * Doppler * Pulse oximeter

Question 38

Arterial cannulation sites (7) * R * U * D * B * F * P * A

Answer 38

* radial * ulnar * dorsalis pedis * brachial * femoral * posterior tibial * axillary

Question 39

Benefit to cannulating radial artery

Answer 39

* easy to cannulate * easy access * adequate collateral circulation (ulnar provides majority of blood flow to hand in 90% of patients)

Question 40

Benefit to cannulating ulnar artery

Answer 40

* if majority of flow to hand is from radial artery then cannulate the ulnar. * If multiple attempts have been made to the radial resulting in hematoma, do NOT use the ulnar!!

Question 41

Radial and ulnar sites are contraindicated in patients with ______ \_\_\_\_\_.

Answer 41

Raynaud's syndrom

Question 42

Cannulating in the brachial artery contraindications:

Answer 42

* location close to elbow may cause kinking * collateral vessels may not be adequate in older patients with vascular disease

Question 43

Cannulating in the femoral artery contraindications

Answer 43

* prone to pseudoaneurysm * atheroma formation following cardiac catheterization * may be only access for burn or trauma victims or for thoracic aortic aneurysm * high rate of ischemic complications * higher rate of infection

Question 44

Cannulating in the dorsalis pedis and posterior tibial points to keep in mind:

Answer 44

* reasonable alternaative to radial or ulnar artery * not present in 5-12% of patients * incidence of thrombolytic occlusion (8%) * SHOULD NOT be used in patients with diabetes or peripheral vascular disease * Allen's test possible by blanching big toe

Question 45

Cannulation in the axillary artery:

Answer 45

surrounds by the axillary nerve plexus--nerve damage **air or thrombus may quickly gain access to the cerebral circulation during flush**

Question 46

When placing art line, need:

Answer 46

* 20g IV catheter * lidocaine * 3ml syringe * betadyne prep * towel roll * transducer * 18g needle

Question 47

How to put in the art line... (4)

Answer 47

* always explain to the patient * determine best site * place patients arm on secure board * PERFORM ALLEN'S TEST

Question 48

What to do when placing art line in:

Answer 48

* ensure hand is in optimal position * palpate * prep * insert 20g catheter * YES, DO USE STEEP ANGLE * look for flash * advance guide wire * advance catheter * remove stylet * attach transducer tubing

Question 49

Radial artery cannulation risks:

Answer 49

* vascular thrombosis * **distal embolization** * **vascular spasm** * accidental drug injection * infection

Question 50

Why do we place central venous line? (7) * pressure * fluid * food * remove things * pacing

Answer 50

* monitoring central venous pressure * fluid administration * infusion of caustic Rx * **total parental nutrition** * air emboli aspiration * transcutaneous pacing leads * poor peripheral access

Question 51

Contraindication to central venous catheter:

Answer 51

* Right atrial tumors * fungating tricuspid valve vegetations

Question 52

Contraindications of central line catheterization relative to site:

Answer 52

* local sepsis * previous vessel damage * suspected injury to IVC or SVC

Question 53

Central venous routes (5)

Answer 53

* Peripheral arm veins (PICC)--usually in basilic or cephalic, good for long term * femoral vein * external jugular * internal jugular * subclavian vein

Question 54

Seldinger's technique for inserting central venous line:

Answer 54

3 fingers up from sternal notch for central line placement

Question 55

Central venous complications (5)

Answer 55

* pneumothorax/ hemothorax * air embolism * arrhythmia * carotid artery puncture * **infection**

Question 56

What lines do we expect for a 24 y/o for 18 hour spinal fusion?

Answer 56

* 2 IVs? * central line because arms are likely to be tucked * A-line

Question 57

What lines do you expect for a 75 y/o with CAD, HTN, CHF for total hip replacement?

Answer 57

2 IVs, art line everything basically

Question 58

46 y/o with ESRD, MWF dialysis for AV fistula revision lines would include:

Answer 58

IV

Question 59

68 y/o for lap assisted colectomy

Answer 59

IV

Question 60

1 unit of blood increases Hct

Answer 60

3 % points

Question 61

Why does a steep increase in lactate indicate need to give blood?

Answer 61

Anaerobic metabolism is occurring and most likely it's volume that is needed.

Question 62

Liver failure patients have ______ lactate values.

Answer 62

increased

Question 63

After blood is transfused, we would expect K to ____ and Ca to ______ .

Answer 63

* increases due to the presence of lysed cells * decreases * Blood celates calcium after blood is given

Question 64

If we see increase in Hct in blood gas report, what do we expect has happened?

Answer 64

little dehydration is occuring

Question 65

If sugar increases drastically in blood gas what has happened?

Answer 65

sympathetic response and catacholamine surge due to loss of blood

Question 66

What is composed of chains of glucose with hydroxyethyl ether?

Answer 66

Hetastarch

Question 67

What fluids are good to give people with Na restrictions?

Answer 67

D5W and D5NS

Question 68

FFP needs exact cross and match. True or false?

Answer 68

false, does not