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block 12 module 4 > Vascular shunts and access > Flashcards

Vascular shunts and access Flashcards

(72 cards)

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1
Q

type of vascular access that is mostly used in clinical practice

A

venous

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2
Q

types of venous access

A

peripheral

central

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3
Q

most common site for percutaneous peripheral catheterization

A

dorsal vein of the hand

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4
Q

why insertion to the lower extremeties is avoided in percutaneous peripheral catheterization

A

to avoid DVT

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5
Q

gauge number for bolus infusion

A

14

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6
Q

Gauge 14 is used for

A

bolus infusion

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7
Q

Gauge 18 is used for

A

volume transfusion

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8
Q

Gauge 16 is uaws for

A

rapid volume infusion

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9
Q

in neonates with fragile veins what gauge num is used

A

24

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10
Q

these are utilized before there were silicone and plastic sets

A

butterfly vein set

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11
Q

common sites for scalp vein cannulation for pedia

A

superficial temporal v
posterior auricular
supratrochlear

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12
Q

Emergency procedure in which the vein is exposed
surgically and then a cannula is inserted into the vein
under direct vision

A

peripheral venous cut down catheterization

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13
Q

why peripheral vein cut-down catheterization is not a favored procedure

A

relative morbidity
relative short patency
technical difficulty in dehydrated and hypotensive patients

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14
Q

primary choice for peripheral venous cut down catheterizatoin

A

great saphenous vein

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15
Q

advantage of central venous access

A
  • long term use
  • allows infusion of solutions that are too concentrated or irritating for the peripheral v
  • allow monitoring of central venous pressure
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16
Q

important indications for central venous access

A

chronically ill px requiring repeated venous punctures for blood sampling and medication

  • emergency access
  • critical care monitoring pwp
  • introduction of pacemakers
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17
Q

if you want to introduce pacemaker what access should you do

A

central venous access

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18
Q

absolute contraindications for central venous access

A

overlying skin and soft tissue infection

thrombophlebitis

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19
Q

why you should not insert a catheter through a thrombus vein

A

you will be removing the thrombus and cause embolus

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20
Q

what are the veins that are utilized in percutaneous polyethylene catheters

A

internal jugular
subclavian
femoral

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21
Q

preferred percutaneous catheterization for long term treatment needs

A

silicone catheters

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22
Q

borders of sedillot’s triangle

A

Sternal head of SCM medially
─ Clavicular head of SCM laterally
─ Superior border of the medial third of the clavicle
inferiorly

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23
Q

most utilized approach for percutaneous subclavian vein catheterization

A

infraclavicular approach

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24
Q

Junction of medial one-third and lateral twothirds

of clavicle

A

clavicular break

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25
most common veins used in PICC line
saphenous or antecubital vein
26
indications for PICC
TPN Blood sampling administration of all medications
27
PICC line eliminate problems of
pneumothorax air embolism cardiac arrhythmia
28
disadvantage of PICC line
increased occlusion rate (small size)
29
Device of choice for patients who require long term or | even permanent access
implantable venous access device
30
advantages of implantable venous access device
less infection less restriction of act L altered body image L dressing changes
31
method for accessing non collapsible venous plexuses thru the bone marrow cavity to systemic circulation
intraosseus access
32
what does the intraosseus method access
non-collapsible venous plexus thru the Bone marroy cavity
33
why intraosseus access was reintroduced in the 1980s
for rapid fluid infusion during resuscitation
34
previous guideline in intraosseus access
only children 6 or younger
35
sites for intraosseus access
``` areas that mature slowly Proximal Tibia below the growth plate Distal tibia above the medial malleolus Distal femur ASIS ```
36
Contraidnications of intraosseous access
- Fractures and crush injuries near the access site - Fragile bone e.g. Osteogenesis imperfecta - Previous attempts to access in the same bone
37
if venous accesss is not available w/in 1 min in a child with CP arrest what should you do
IO cannulation | IO needle placed in anterior tibia
38
indications for catheterization of Umb V
IV access in low birth weight infants (not more than 2 weeks) Emergency IV access for resuscitation, medication, and fluids Blood sampling Monitoring of central venous pressure Exchange transfusion in the newborn
39
indications for catheterization of Umb A
``` Continuous blood-pressure monitoring Exchange transfusion in the newborn Arterial blood gas sampling Infusion of resuscitation drugs Infusion of maintenance solutions ```
40
risks in umb v/a catheterization
cardiac perforation pericardial tamponade portal HPN
41
if the catheter is incorrectly placed in the RA during umb v/a cat what could happen
cardiac perforation or pericardial tamponade
42
this assess blood gases and to continuously monitor blood pressure (critically ill patients), invasive radiologic interventional procedures
arterial vascular access
43
sites used in arterial vascular access
radial axillary femoral posterior tibial dorsalis pedis
44
what arterydo most interventional cardiologist utilize for coronary angiogram?
radial artery
45
arteries that should be avoided in arterial vascular access
brachial | temporal
46
what would you perform first if you want to access arteries of the hand
allen's test esp in px with peripheral arteriosum causing dse
47
why allen's tetst is performed before radial artery cannulation
to determine wheter ulnar collateral circulation to the hand is adequate in case of radial art thrombosis
48
most commonly cannulated artery
radial
49
why ulnar artery is less commonly used
bcoz of its proximity to the ulnar nerve
50
this is used to make a passage or anastomosis btn 2 natural channels
vascular shunts
51
this is used for damage control surgery
vascular shunts
52
indications for temporaray intravascular shunting
Open extremities fractures with extensive soft tissue injury and concurrent arterial injury (Gustillo IIIC) Need for perfusion during complex vascular reconstruction Damage control for patients in extremities Perfusion prior to limb replantation Truncal vascular control Complex repair of zone III neck injuries
53
Used to graft aneurysms, to bypass occlusion or served | as catheterizing device especially in trauma
temporary limb salvage shunt
54
this is used for blockade of the common carotid artery
brachial artery shunt
55
this shunt istemporarily installed to maintain perfusion towards the brain while removing the thrombus area (thickened intima)
brachial artery shunt
56
this is used in congenital anomalies esp TOF
modified Blalock taussig shunt
57
what arteries are connected in B-T shunt
pulmo and subclavian
58
Surgically created connection between a vein and an | artery
av fistula
59
av fistula is usually in
forearm
60
this allow access to the vascular system for adequate blood | flow during hemodialysis
av fistula
61
why av fistula is superior to graft and catheters
Increased patency Decreased morbidity Decreased cost
62
gold standard for hemodialysis access
av fistula
63
advantages of av fistula
good flow for dialysis last longer less likely to get infected or cause blood clots
64
disadvantages of av fistula
requires 2-3 mos to develop or mature requires good inflow artery and good outflow vein Vein mapping sometimes needed
65
acute complications of vascular access
Pneumothorax Vascular damage (perforation, dissections) Air embolism Aberrant catheter placement Damage to the thoracic duct Cardiac complications (Cardiac irritation, cardiac perforation) Local tissue trauma or damage (bleeding into surrounding tissues, nerve injury)
66
long term complications of vascular access
``` Infection and sepsis catheter induced septicemia Thrombotic complications (DVT, pulmonary embolus) Phlebitis of the cannulated vessel Superior vena cava syndrome Catheter dislodgement and migration ```
67
A 5 day old infant has to undergo arterial blood gas monitoring, which is the best access site to be used?
umbilical artery
68
Patient ICU needs total parenteral nutrition. | Which is the best catheter to be used for this?
peripherally inserted central catheter
69
Which CVC site is the easiest access in a trauma | code situation
femoral
70
Considered in hemodialysis patients who are older and/or has small veins and are not considered good candidates for AV fistula.
av graft
71
Beneficial for cancer patients who requires | repeated access for chemotherapy
implantable venous access device
72
What is the ideal time to use a winged infusion set?
for IV push drugs

block 12 module 4 (2 decks)

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