CENTRAL VENOUS CATHETERIZATION: MCQ POINTS

central venous catheterisation:

INDICATION:
1) Monitoring central venous pressure for fluid management of hypovolemia and shock.
2)giving total parenteral nutrition.
3) infusion of caustic drugs that cause phlebitis when infused through peripheral vein as hypertonic saline,  calcium chloride.
4)aspiration of air emboli.
5)insertion of transcutaneous pacing leads.
6) gaining venous ascess in patients with poor periferal veins.

some NEET/DNB points:
1) non tunneled catheters are fixed at site of insertion eg Quinton catheter and catheter and attachment come out directly
2) tunneled catheter r passed under the skin to a separate exit site eg Hickman catheter & Groshong catheter. These catheter have decreased chance of infection and dislodgement.

PROCEDURE:
Q1) Which site of Central venous line is best for long term use…
a. basilic
b. external jugular
c. internal jugular
d. subclavian
e.  femoral

ans ; d ) subclavian
rating d>c>b>a>e ie femoral vein is least suitable for long term use.
REF Pg 100 lange clinical anesthesiology 3e.

Q2) technique related complications are most likely to occur with which site….
a)basilic
b) external jugular
c) internal jugular
d) subclavian
e) femoral

ans : d ) subclavian
rating. d>b>e>b>a ie technique related complications are most likely to occur with subclavian and least likely in basilic vein.
Ref : pg 100 lange clinical anesthesiology 3e.

Q3) according to ease of cannulation best site is. ..
a) basilic
b) external jugular
c) internal jugular
d) subclavian
e) femoral

ans: a)basilic vein
best to worst list a>c>b=e>d
Ref: pg100 lange clinical anesthesiology 3e.

NOTE: RIGHT INTERNAL JUGULAR VEIN PROVIDES A COMBINATION OF ACCESSIBILITY AND SAFETY FOR CENTRAL VENOUS CATHETERISATION.

* Seldinger technique is used ie insertion of catheter over guide wire.
* placing the patient in trendelenberg position while catheterising decreases the chance of air embolism & distends the vein.
*catheter tip should not be allowed to migrate in heart chambers which if happens can lead to arrythmias.
*central venous pressure= right atrial pressure = major determinant of right ventricular end diastolic volume.

COMPLICATIONS:
Infection, air embolism,  thrombosis,pneumo/hydro /chylo thorax,  arrythmias, cardiac perforation,  tamponade.

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