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Hemostasis
Homework -- Hemostasis test 11-21
| Question | Answer |
|---|---|
| Hey pulsatile encapsulated hematoma in communication with a ruptured artery is a | Pseudoaneurysm |
| An artery to vein shunt is an | A-V fistula |
| A fusiform aneurysm is | What an abdominal aortic aneurysm looks like a true aneurysm shaped like a vase |
| Dissecting aneurysm: | One layer of vessel is starting to rip, not only just bulge, ticking time bomb |
| Embolism | Clot comes off introducer gets left behind |
| You are establishing hemostasis on a patient post cat who has both arterial and venous sheets. Pulling the arterial line first: | Reduces the risk of an arteriovenous fistula, and if you still have a venous line in you can still push meds |
| True or false: pulling the arterial line first on a patient postcast who has both arterial and venous sheets increases the risk of vasovagal reaction | False, it decreases the risk of vasovagal reaction |
| Postkasse, a patient's leg is hopeless, cold and painful. You notify the physician. You should also: | Inquire as to an order for anticoagulants and pain medication |
| Possible complications of the femoral line removal are: infection, vasovagal reaction, distal embolisation, pseudoaneurysm, hematoma | All of the above |
| Immediate treatment for a bagel bagel reaction includes atropine 0.5 milligrams IVP, IV fluid bolus, put patient in Trendelenburg position | All of the above |
| 12 hours following in geography a patient develops a painful pulsatile mass just below the skin at the femoral artery function site. A femoral artery bruit can be heard with the stethoscope. What is the most likely complication? | False aneurysm |
| What is a bruit? | Turbulent sound - blood leaving vessel and gurgling into the neck of the pseudoaneurysm |
| Acute femoral arterial occlusion following catheterization presents with all the following clinical signs and symptoms except? Leg pain, leg paralysis, warm sweaty leg, pulseless leg, leg numbness, pain or mottled leg color | Warm sweaty leg, it would be cold. |
| Bleeding under the skin from a vascular catheterization site is termed af an: | Hematoma |
| After holding pressure on a femoral artery for 15 minutes, the grind appear swollen with the two plus pulse. Pedo pulses are plus one and the leg is cool. What vascular complication is this? | Femoral rhombus |
| What should the difference between the pedal pulse and the femoral pulse be? | They should be the same. You don't want to lose the distal pulse. |
| Certain patients are prone to developing hematomas. On which type of patients should extra care be taken to establish full hemostasis? | Patients with aortic regurgitation, you can't get the clot stabilized |
| True or false: patients with low cardiac output pretty quickly due to low pressure | True |
| You have health pressure on a heart cath patients RSA for 15 minutes. You slowly remove your fingers and see that the bleeding has stopped. But, you know a soft and stable quarter inch high swelling, about 1 inch in diameter. You should: | Circle the swollen area with a pen and then watch the puncture site for 2 to 3 minutes more for further swelling. |
| True or false: if a hematoma continues to grow after you circle the swollen area with a pen you have hemostasis | False, you only have hemostasis if it stops growing |
| You have held pressure on a heart cath patients RFA for 15 minutes. You slowly remove your fingers and see that the bleeding has stopped. You feel a new hard 2 inch wide swelling beneath the puncture site. You should | Continue compression for 20 more minutes |
| On which IV access site is hemostasis most difficult to achieve? | Subclavian vein |
| After a diagnostic RFA cath, the catheter has been removed, sheath flushed & ECG leads removed. Pt has minor bleeding around sheath site. The Pt needs to be moved to a holding area where you will pull the sheath. How should he be moved to the stretcher? | Hold the patient's groin at the sheath insertion site while coworkers slide him over on a roller board or surfboard |
| When instructing a Pt after femoral arteriography, all the directions below are ok except: press on wound if you have to cough, drink lots of fluids, elevate the head of the bed no higher than 30 degrees, you may get up to go to the bathroom | The patient should be instructed not to get up to go to the bathroom |
| True or false: a Post radial arteriography patient may have the head of the bed elevated 90 degrees | true |
| **How long should pressure be applied post cath? | 10 minutes for everyone + 2 minutes per sheath size |
| After Lt heart cath + coronary arteriography the femoral artery sheath is pulled out of the artery and homeostasis is established. To accomplish this the puncture site should normally be held for --to --Min. with pressure at the vascular puncture site | 10 to 20 minutes, 2 to 3 fingers digital |
| You are about to establish hemostasis following RFA catheterization. Prior to pulling the sheath you should position your | Left index finger just superior to the skin puncture |
| ***When pulling a sheath, how much pressure should be exerted on the femoral artery, after initial bleeding has been stopped? | just enough so a faint pulse is felt in the foot for 5 minutes, then taper off (patent hemostasis, not occlusive) |
| *After a Rt + Lt heart cath from the Rt leg, Both arterial and venous sheets remain in the groin. The safest method to establish hemostasis for both vessels is to: | First remove the arterial sheath and apply pressure to that site for 15 minutes and then remove the other sheets and hold pressure on the vein for 10 minutes |
| When palpating pedal pulses during hemostasis the posterior tibial artery is located | Behind the medial malleolus (ankle bone) |
| Hemostasis is defined as: | The act of stopping bleeding. It is the body's natural response to vascular injury. It occurs in a series of steps that results in a fibrin clot. |
| Why would a patients ability to clot be affected by liver disease? | Because they don't make fibrinogen |
| Why would a patients ability to clot be affected by thrombocytopenia? | They don't have enough platelets. |
| The patients ability to clot may be affected by: | The administration of anticoagulants, decreased vascular tone of the vessel, liver disease, thrombocytopenia |
| Prior to selecting a method of hemostasis the following variables should be assessed: | The presence of peripheral vascular disease, arterial access location, potential mean to read access the same groin |
| Poly-N-acetylglucosamine (pGlcNAc polymer) is the active ingredient in: | The Syvek patch |
| Your patient develops a pseudo aneurysm two days after transfemoral catheterization. How can it be most easily repaired? | Inject procoagulant (thrombin) into the false aneurysm |
| When can a Perclose vascular closure device be used? | Only when you still have the sheath in |
| Retroperitoneal bleeding | Can kill patient; repair in o.r |
| How can you repair an AV fistula | Embolization coil |
| How do you handle a hematoma? | Control with pressure manual and clamp |
| Injection of thrombin using Doppler ultrasound guidance is a treatment for | Pseudoaneurysm |
| Postc a few of pulled a 6 French arterial she's. After a few minutes your patient develops both a hematoma and a vasovagal reaction. | Continue holding pressure to control hematoma, have patient cost to increase heart rate and blood pressure while you summon assistance get atropine |
| After pulling a 5 friend she's at the end of the femoral artery case, how long should you hold pressure to achieve hemostasis? | 15 to 20 minutes |
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ICVT2b
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