jean38112

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Author:
jean38112
ID:
8081
Filename:
jean38112
Updated:
2010-02-25 00:56:15
Tags:
cardio cardiac invasive cath
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Description:
anesthesia cath lab
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  1. what are the 2 types of lidocaine falmily?
    ester and amide
  2. ester family includes?
    • benxocaine(americaine, solarcaine)
    • cocaine
    • procaine(novocaine)
    • tetracaine(pontocaine)
  3. Amide family includes?
    • lidocaine(xylocaine)
    • mepivacaine(carbocaine)
    • prilocaine(cinanest)
    • bupivacaine(marcaine)
  4. instruments needed for Cut-down procedure
    • #15 knife blade on handle
    • #11 knife blade on handle
    • 4-5 curved mosquito hemostats
    • 2 straight hemostats
    • weitlander self retaining retractor
    • iris scissors
    • needle holder
    • debakey forceps
    • adson doeceps with teeth
    • umbilical tape
    • non absorbable 6.0 prolene
    • 3-0 absorbable suture(vicryl)
    • silk suture
  5. how to obtain femoral approach
    risk of retroperitoneal bleed if not felt and punctued accurately

    • feel iliac crest and pubic bone (imagingary line)
    • you should feel the inguinal ligament
    • go 2cm below that ligament
    • if above the inguinal ligament you can cause retroperitoneal bleed
  6. locating the vessels
    in the femoral approach

    going lateral to medial feel for

    • Nerve
    • Artery
    • Vein
    • Empty space or epithilial tissue
    • Lymph
  7. lidocaine info
    • 2% is most commonly used
    • don't use novocaine b/c it contains epi, which will constrict the blood vessels, and will not be ablt to get access

    increases HR & BP iff in blood stream
  8. how much lidocaine used for 1 stick method
    1 syringe filled with 2% lidocaine

    • 10cc for femoral
    • 5cc for radial
  9. how much lidocaine used for 2 stick?
    2 syringes with 10cc lidocaine

    • 1 has short needle for superficial tissue
    • 1 has long needle for deeper tissue

    can use up to 20 cc on average 15cc
  10. problems with access

    got access, loose blood flash
    • pull back 1 cm or less, look for flash
    • if don't see flash then pull back a little more
    • if see flash, put wire back in
    • if don't see flash, remove needle, flush needle, hold pressure for 5 min
  11. got access see blood flash, wire won't advance. what next?
    • pull back 1 cm or less, look for flash
    • if don't see flash then pull back a little more
    • if see flash, put wire back in
    • if don't see flash, remove needle, flush needle, hold pressure for 5 min
  12. what is manual pressure?
    • assisted pressure to groin after procedure
    • hold for 15min
    • if you peak you leak and have to start all over
    • for aortic regurge hold for 30 min
  13. 5 types of closure devices?
    • vasoseal
    • angioseal
    • perclose
    • startcloser
    • boomerang
  14. vasoseal includes what?
    • 2 hr bed rest
    • gives solid seal

    • insert wire
    • remove sheath and hold occlusive pressure
    • insert sheath until blood flash
    • push dilator in until blck mark on sheath is met at hub
    • hold occlusive pressure, pull dialtor
    • insert plunger, push collagen into track ( 2 plugs) remove hub
    • hold pressure for 5-15 min
  15. angioseal includes what?
    • 2-4 hr bedrest, mostly 2 hr
    • most commonly used by MD's.

    • with sheath already intact you will
    • insert angioseal wire
    • remove sheath
    • insert angioseal sheath until blood flash seen
    • remove wire and dilator, your then committed to artery,
    • open closure device
    • insert device into sheath
    • pull sheath and device back very carefully
    • tamp collagen and foot together
    • cut suture, remove device

    • can cause phlebitis(vasculitis)
    • absorbable in pt
    • can use with anticoagulants
  16. perclose device includes what?
    sutures arteriotomy closed

    • insert wire into sheath
    • remove sheath
    • insert perclose device
    • remove wire=committed
    • deploy needle and suture
    • remove device
    • tie suture
    • advance knot
    • cut suture length

    pt can walk right away with this device
  17. starcloser includes what?
    • same steps as perclose
    • except it is uses staples and not sutures

    • can use with high ACT
    • if miss with this device you will have to hold mannually
  18. boomerang includes what?
    • 2-6 hr bedrest
    • same steps as perclose and starcloser, except it has a little foot which is inserted,
    • pull back carefully till feel small resistance as you pull, hold for 10-15 min
  19. What types of patients can not use perclose, starcloser and angioseal?
    • pt that has had a side stick to artery
    • pt that has small vessels
    • pt that has bifurcations
    • pt that has stenosis

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