Vascular shunts and access Flashcards Preview

block 12 module 4 > Vascular shunts and access > Flashcards

Flashcards in Vascular shunts and access Deck (72):
1

type of vascular access that is mostly used in clinical practice

venous

2

types of venous access

peripheral
central

3

most common site for percutaneous peripheral catheterization

dorsal vein of the hand

4

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

to avoid DVT

5

gauge number for bolus infusion

14

6

Gauge 14 is used for

bolus infusion

7

Gauge 18 is used for

volume transfusion

8

Gauge 16 is uaws for

rapid volume infusion

9

in neonates with fragile veins what gauge num is used

24

10

these are utilized before there were silicone and plastic sets

butterfly vein set

11

common sites for scalp vein cannulation for pedia

superficial temporal v
posterior auricular
supratrochlear

12

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

peripheral venous cut down catheterization

13

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

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

14

primary choice for peripheral venous cut down catheterizatoin

great saphenous vein

15

advantage of central venous access

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

16

important indications for central venous access

chronically ill px requiring repeated venous punctures for blood sampling and medication
-emergency access
-critical care monitoring pwp
-introduction of pacemakers

17

if you want to introduce pacemaker what access should you do

central venous access

18

absolute contraindications for central venous access

overlying skin and soft tissue infection
thrombophlebitis

19

why you should not insert a catheter through a thrombus vein

you will be removing the thrombus and cause embolus

20

what are the veins that are utilized in percutaneous polyethylene catheters

internal jugular
subclavian
femoral

21

preferred percutaneous catheterization for long term treatment needs

silicone catheters

22

borders of sedillot's triangle

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

23

most utilized approach for percutaneous subclavian vein catheterization

infraclavicular approach

24

Junction of medial one-third and lateral twothirds
of clavicle

clavicular break

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