Clinical Procedures & Techniques Flashcards

During a modified Seldinger PICC insertion, the guidewire has been threaded through the access needle. What is the next step?

Answer: Remove the needle while holding the wire, then advance the microintroducer-dilator over the wire

In MST the needle is removed over the wire, a small skin nick is often made, and the introducer-dilator is advanced over the guidewire.

Using the Zone Insertion Method (ZIM), which part of the upper arm is the preferred 'green zone' for PICC insertion?

Answer: The middle third of the upper arm

The ZIM green zone is the middle third of the upper arm, which avoids elbow flexion and the moist, high-bacteria axillary area.

Current INS guidance recommends a catheter-to-vein ratio of no more than what percentage to lower the risk of thrombosis?

Answer: 45%

INS recommends a catheter-to-vein ratio of 45% or less, and less is better, to reduce catheter-related thrombosis.

Where should the tip of a central vascular access device ideally sit in an adult?

Answer: Lower third of the superior vena cava at or near the cavoatrial junction

The optimal CVAD tip position is the lower third of the SVC at or near the cavoatrial junction.

With intracavitary ECG tip confirmation, which P-wave change shows the catheter tip has gone past the cavoatrial junction into the right atrium?

Answer: A biphasic P wave with an initial negative deflection

The peak P wave marks the cavoatrial junction, and a negative or biphasic deflection means the tip is in the right atrium and should be pulled back.

During out-of-plane (short-axis) ultrasound-guided cannulation, how does the needle tip usually appear?

Answer: As a bright hyperechoic dot on the screen

In short axis the beam crosses the needle, which shows up as a hyperechoic dot, and you must walk the probe forward to keep the tip in view.

On ultrasound, which finding best tells a vein apart from an adjacent artery?

Answer: The vein collapses with light probe pressure and does not pulse

Veins compress easily and do not pulse, while arteries resist compression and pulsate.