ACVNU flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Central venous pressure normal range

CVP reflects right atrial pressure and normally ranges about 2–8 mmHg. Trends and response to fluid challenge are more useful than a single measurement.

Internal jugular vein anatomy

The internal jugular vein lies deep to the sternocleidomastoid muscle and lateral to the carotid artery. Ultrasound identification of the carotid is essential before puncture.

Subclavian vein landmarks

The subclavian vein passes between the first rib and clavicle. Its proximity to the pleura and subclavian artery increases the risk of pneumothorax and arterial puncture.

Vein versus artery on ultrasound

Veins appear as thin-walled, compressible, anechoic structures. Arteries are thick-walled, pulsatile, and resist compression; color Doppler confirms flow.

Short-axis versus long-axis view

Short-axis (transverse) view shows vessels as circles and helps identify adjacent structures. Long-axis view shows the needle shaft and tip entering the vessel lumen.

Needle tip visualization technique

Keep the needle tip visible throughout advancement. If the tip is lost from view, withdraw to the skin and redirect rather than advancing blindly.

Lung sliding on ultrasound

Normal lung sliding indicates the visceral and parietal pleura are apposed. Absence of sliding after central access suggests pneumothorax and requires chest imaging.

Peripheral IV gauge selection

Use 14–16 G for rapid resuscitation or blood products, 18–20 G for most adult therapies, and 22–24 G for small veins, older adults, or pediatrics.

Central catheter tip location

The tip should sit at the cavoatrial junction or lower superior vena cava. Right atrial placement increases risk of arrhythmia and cardiac perforation.

Midline catheter limitations

Midline catheters end in upper-arm veins and are not appropriate for vesicant, hyperosmolar, or vasopressor infusions that require central venous flow.

Port access needle type

Implanted ports require a non-coring (Huber) needle. Confirm placement by blood aspiration and flush before infusing any medication.

Positive pressure flushing

Flush with at least 10 mL sterile saline using push-pause technique, then clamp while maintaining positive pressure to prevent blood reflux and occlusion.

Central line dressing schedule

Change transparent semipermeable dressings every 5–7 days and gauze dressings every 2 days. Replace any damp, loose, or soiled dressing immediately.

Catheter removal technique

Position the patient supine or Trendelenburg, remove during expiration or Valsalva, apply an occlusive dressing, and inspect the catheter tip for integrity.

Arterial puncture management

Remove the needle and apply sustained pressure for at least 5–10 minutes, longer if coagulopathic. Confirm hemostasis and monitor for hematoma or pseudoaneurysm.

Air embolism positioning

Place the patient in Trendelenburg and left lateral decubitus position, give 100% oxygen, and aspirate air from the catheter if a central line is present.

Extravasation first steps

Stop the infusion, aspirate residual drug through the catheter, elevate the limb, and apply the appropriate antidote per policy. Document site and agent.

Catheter-related thrombosis signs

Suspect thrombosis with unilateral arm swelling, pain, or visible collateral veins. Confirm with duplex ultrasound; treat with anticoagulation and remove catheter if not needed.

Pneumothorax after central access

Suspect with chest pain, dyspnea, decreased breath sounds, and tracheal deviation. Confirm with chest radiograph or ultrasound; tension pneumothorax needs immediate decompression.

Phlebitis recognition

Phlebitis presents as erythema, induration, and pain along the vein. Remove the catheter, apply warm compresses, and document the grade and site.

Maximal sterile barrier precautions

For central line insertion use cap, mask, sterile gown, sterile gloves, and full-body sterile drape, plus hand hygiene before and after the procedure.

Skin antisepsis for access

Chlorhexidine gluconate 2% in 70% isopropyl alcohol is preferred for adults. Allow the antiseptic to dry completely before puncture.

Hub disinfection technique

Scrub the catheter hub with 70% alcohol or chlorhexidine for at least 15 seconds and allow it to dry before accessing the line.

Daily line necessity review

Review central lines daily and remove them as soon as no longer indicated. This is a core element of central line-associated bloodstream infection prevention.

Hand hygiene importance

Hand hygiene is the single most effective measure to prevent healthcare-associated infection. Perform it before and after patient contact and catheter manipulation.

Informed consent elements

Document discussion of purpose, risks, benefits, and alternatives, and confirm patient understanding before vascular access procedures.

Procedure documentation requirements

Document date and time, indication, consent, site, catheter type and size, attempts, ultrasound use, complications, confirmation method, and patient tolerance.

Two patient identifiers

Verify two identifiers before any procedure or medication. Also confirm allergies, especially to chlorhexidine, lidocaine, and latex.

Error disclosure obligation

Report adverse events and near misses through the institutional system and disclose to the patient or family per policy and ethical obligations.

Indications for central access

Central access is indicated for vasoactive infusions, caustic or hyperosmolar therapy, hemodynamic instability, inadequate peripheral access, and long-term antibiotic or nutrition therapy.

Catheter-related bloodstream infection signs

Suspect with new fever or rigors, especially within 2 hours of infusing through the line, unexplained leukocytosis, or hypotension without another source.

Distal perfusion assessment

Assess pulse, color, temperature, capillary refill, sensation, motor function, and pain before and after every catheter placement or dressing change.