IBHRE Patient Safety and Radiation Management 2 — Questions and Answers
Question 1: Cardiac tamponade during an EP procedure is recognized by which constellation of findings?
- Hypertension and bradycardia
- Hypotension, elevated venous pressure, and equalized diastolic pressures (Correct answer)
- Isolated sinus tachycardia
- ST-segment elevation in anterior leads
Correct answer: Hypotension, elevated venous pressure, and equalized diastolic pressures
Tamponade produces Beck's triad of hypotension, elevated jugular venous pressure, and muffled heart sounds, with equalization of diastolic pressures across cardiac chambers.
Question 2: Why is systemic heparin anticoagulation routinely administered during left-sided EP procedures?
- To prevent hematoma at the femoral access site
- To prevent thromboembolism from catheter and sheath surfaces in the left heart (Correct answer)
- To reduce post-procedure pulmonary embolism risk only
- To decrease ablation lesion size
Correct answer: To prevent thromboembolism from catheter and sheath surfaces in the left heart
Heparin prevents thrombus formation on intracardiac catheters and sheaths within the left heart, reducing the risk of systemic thromboembolism and stroke.
Question 3: Air embolism during EP procedures is prevented primarily by?
- Using dry needles for vascular access
- Careful flushing and de-airing of all sheaths and catheters before insertion (Correct answer)
- Using the smallest available catheter size
- Rapid catheter insertion to minimize air entry time
Correct answer: Careful flushing and de-airing of all sheaths and catheters before insertion
Thoroughly flushing and de-airing all intravascular sheaths, introducers, and catheters with saline before insertion prevents air from entering the vasculature.
Question 4: The 'safe zone' for femoral vascular access lies?
- Above the inguinal ligament over the external iliac vessels
- Below the inguinal ligament where the common femoral vessels are accessible (Correct answer)
- Within the femoral triangle near the knee
- Medial to the femoral nerve only
Correct answer: Below the inguinal ligament where the common femoral vessels are accessible
The common femoral artery and vein should be accessed below the inguinal ligament to avoid the external iliac vessels and reduce retroperitoneal hematoma risk.
Question 5: Vascular closure devices (VCDs) after EP procedures are primarily used to?
- Prevent access site infection
- Achieve hemostasis with reduced manual compression time (Correct answer)
- Monitor post-procedure blood pressure
- Prevent deep venous thrombosis
Correct answer: Achieve hemostasis with reduced manual compression time
Vascular closure devices seal the arterial or venous puncture site using collagen plugs, sutures, or clips, significantly reducing manual compression time and patient discomfort.
Question 6: Post-procedure pseudoaneurysm formation at the femoral access site is most commonly associated with?
- Venous access with small sheaths
- Arterial access with inadequate hemostasis or high puncture (Correct answer)
- Use of vascular closure devices
- Anticoagulant reversal immediately after the procedure
Correct answer: Arterial access with inadequate hemostasis or high puncture
Pseudoaneurysms form when inadequate sealing of an arterial puncture allows persistent blood flow into surrounding tissues, most common after arterial access with poor compression.
IBHRE Patient Safety and Radiation Management 2
Cardiac tamponade during an EP procedure is recognized by which constellation of findings?