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Questions and Answers
What is the primary purpose of applying a tourniquet during venous cannulation?
What is a relative contraindication for venous cannulation?
Which of the following is a consideration for choosing the non-dominant upper extremity for venous cannulation?
What is the recommended technique for cleaning the skin before venous cannulation?
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What is the purpose of rubbing or warming the skin around the target vein?
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What is the recommended approach for locating a suitable vein for cannulation?
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How should the cannula be held during venous cannulation?
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What is the purpose of stabilizing the vein during venous cannulation?
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What is the benefit of instructing the patient to repeatedly open and close their hand during venous cannulation?
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What is the recommended site for venous cannulation in terms of convenience and risk?
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Study Notes
Central Line Placement
- Strict aseptic technique is essential, including handwashing, gowning, draping, and sterile preparation of the access site.
Insertion Technique
- Infiltrate the skin with 1% Lidocaine around the insertion site.
- Insert an 18-gauge introducer needle at a 45-degree angle at the apex formed by the two heads of the SCM.
- Advance the needle lateral to the carotid pulsation, directed towards the ipsilateral nipple, while aspirating.
- Once venous blood is aspirated, remove the syringe and thread the guidewire through the introducer into the vessel up to the superior portion of the IVC (~15-16cm for Right IJV).
ECG Tracing
- P-wave: Atrial depolarization
- PR interval: Conduction from atria to ventricles
- PR segment: Reference isoelectric line
- QRS complex: Ventricular depolarization
- QT interval: Duration of ventricular depolarization to repolarization
- ST segment: Plateau phase of the cardiac cell potential
- T-wave: Ventricular repolarization
ECG Placement
- Limb leads: Standard (I, II, III) and augmented (aVR, aVL, aVF)
- Chest leads: V1-V6, with specific placement locations
Contraindications
- No absolute contraindications
- Relative contraindications: Local infections and burns on the intended site of insertion, and arteriovenous fistula formation or deep vein thrombosis on the affected limb
Site Selection
- Internal jugular vein: Right IJV is often preferred due to its direct route to the right atrium
- Subclavian Vein: Provides a direct route to the right atrium but has higher risk for pneumothorax and bleeding
- Femoral vein: Used for patients with high risk of bleeding, but generally avoided due to increased risk of catheter-related deep vein thrombosis
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Description
This quiz covers the steps involved in accessing and inserting an ECG device, including aseptic technique, handwashing, and needle insertion.
