Implantable Medical Technology: Implanted Medical Devices and Central Venous Access Lines Flashcards

Flashcards covering key concepts related to Implantable Medical Devices and Central Venous Access Lines, including VADs and CVADs, from lecture notes to prepare for an exam. This set includes 70 Question and Answer format flashcards.

What do implanted medical devices offer to patients with complex medical conditions?

Life-saving interventions

What is the primary purpose of implanted medical devices?

To improve patient outcomes, enhance quality of life, and provide critical therapeutic options

What are two significant categories of implanted medical devices mentioned?

Ventricular assist devices (VADs) and central venous access lines (CVADs)

What are Ventricular Assist Devices (VADs)?

Mechanical pumps supporting heart function in patients with severe heart failure

What are Central Venous Access Lines (CVADs)?

Specialized catheters providing reliable vascular access for medication administration, fluid delivery, and long-term treatments

How do ventricular assist devices function in terms of cardiac hemodynamics?

They create a parallel circulatory pathway that assumes primary responsibility for systemic blood flow

What is the first step in how a VAD works, regarding blood extraction?

The device continuously pulls blood from the failing left ventricle through an inflow cannula

Where does the VAD deliver blood after pumping it?

Directly into the aorta, bypassing the compromised cardiac function

What is the VAD therapeutic application known as "Bridge to Transplantation"?

Patients awaiting heart transplant who require mechanical support to maintain adequate perfusion during the waiting period

What is "Destination Therapy" for VAD implementation?

Patients whose hearts require long-term mechanical assistance due to irreversible cardiac dysfunction

What is the purpose of VAD implementation for "Bridge to Recovery"?

Patients whose hearts are healing from acute injury or illness and need temporary support until native function returns

What epidemiological trend has led to a rise in VAD utilization?

An aging population combined with increasing prevalence of heart failure

Why is paramedic familiarity with VAD technology critical?

They are encountering these patients with greater frequency in prehospital care

What is a critical statistic regarding heart failure patients that makes VADs essential?

Heart failure patients typically have a 5-year mortality rate

How do VADs fundamentally alter cardiovascular assessment parameters?

They require specialized evaluation techniques and conventional methods may provide misleading information

What specific traditional measurements may provide misleading clinical information in VAD patients?

Traditional blood pressure, pulse, and oxygen saturation measurements

What critical alert is associated with continuous-flow VADs regarding pulses?

They eliminate pulsatile flow, resulting in the absence of palpable peripheral pulses

What therapy are ALL VAD patients maintained on?

Anticoagulation therapy

How can cardiac function be assessed in a VAD patient using a stethoscope?

Utilize a stethoscope over the cardiac apex; an audible humming confirms device function

What method is required for blood pressure evaluation in a VAD patient?

Doppler ultrasound is required for MAP (Mean Arterial Pressure) determination

What are indicators of good perfusion in a VAD patient?

Pink, warm, dry skin; alert and oriented mental status; capillary refill less than 2 seconds

What device parameter should be checked as an indicator of VAD performance?

Battery charge levels and peripheral edema

What is the drive line for a VAD?

The critical connection between internal VAD components and an external power source

What is a prohibited action regarding the VAD drive line connection?

Never bend, twist, pull, or apply excessive force to the drive line connection

Why is dressing integrity important for the VAD drive line?

To maintain a sterile, intact dressing at the exit site to prevent infection

What is the main clinical importance of drive line integrity?

It is essential for maintaining continuous mechanical circulatory support, as compromise can result in immediate hemodynamic instability

How should hypovolemia be managed in VAD patients?

Assess skin color, temperature, LOC, and utilize IV fluid administration per ALS/PCS protocols

Why is nitroglycerin administration cautioned in VAD patients with ischemic chest pain?

Due to the inability to confirm blood pressure through conventional means; Base Hospital must be contacted before administration

What alternative cardiac arrest indicators are used for VAD patients lacking an arterial pulse?

Assess responsiveness, perfusion status, and auscultate for device humming sound

What should be verified immediately in a VAD patient suspected of cardiac arrest?

DNR status

If a VAD patient is unresponsive with poor perfusion and absent device function, what initial action should be taken?

Initiate CPR while considering early transport due to hemorrhage risk

What critical warning is associated with CPR in VAD patients?

CPR carries significant hemorrhage risk as chest compressions may dislodge the mechanical pump

What are Central Venous Access Devices (CVADs)?

Sophisticated vascular access systems designed to provide reliable, long-term venous access for complex medical treatments

Which CVAD classification involves insertion into peripheral veins with the catheter tip positioned centrally?

Peripheral Lines

Which CVAD classification involves direct insertion into large central veins near the heart?

Central Lines

Which CVAD classification consists of subcutaneous access ports connected to central catheters?

Implanted Ports

What is the Primary Care Paramedic (PCP) restriction regarding CVAD access?

PCPs are NOT permitted to utilize CVAD access in place of standard IV initiation under any circumstances

When is CVAD access permitted for Advanced Care Paramedics (ACPs) in a prehospital setting?

Only when the patient is in a prearrest or cardiac arrest state AND peripheral IV access cannot be obtained

Which type of CVAD are ACPs prohibited from accessing?

Implanted ports, due to specialized equipment requirements

How is a Peripherally Inserted Central Catheter (PICC) line inserted?

Through peripheral veins in the upper arm, advanced until the catheter tip reaches a large central vein like the superior vena cava

What is a benefit of the peripheral insertion approach for PICC lines compared to central insertion?

Reduces infection risk while maintaining the benefits of central venous access

What do implanted ports consist of?

A subcutaneous reservoir connected to a catheter inserted into a central vein

What specialized needle is required to access an implanted port?

A Huber needle

How are tunneled central venous catheters surgically inserted?

With the catheter body tunneled under the skin before entering the central vein

What is the benefit of tunneling for tunneled catheters?

It creates a physical barrier that significantly reduces infection risk

For what duration are non-tunneled central venous catheters designed?

Short-term use in acute care settings

Into which central veins are non-tunneled catheters typically inserted?

Internal jugular, subclavian, or femoral veins

What is one benefit of CVADs for medication administration?

Enable direct and efficient delivery of medications, fluids, and nutrients into central circulation for rapid systemic distribution

How do CVADs assist with hemodynamic monitoring?

Facilitate continuous monitoring of parameters like central venous pressure and central venous oxygen saturation

What is a benefit of CVADs regarding reduced peripheral complications?

Reduced peripheral vein damage and decreased risk of peripheral infiltration and phlebitis

Where are peripheral central venous access lines typically inserted?

In peripheral arm veins (basilic or cephalic veins), then advanced to the superior vena cava or right atrium

What are peripheral central access lines appropriate for in terms of duration?

Short to intermediate-term use, ranging from several days to weeks

How do implanted medical devices enhance quality of life?

By managing chronic conditions and reducing hospital dependency

What do implanted devices enable regarding clinical monitoring?

Continuous monitoring of vital physiological parameters and immediate therapeutic intervention capability

How do implanted devices reduce hospitalizations?

By effective management of medical conditions

What is a significant risk associated with VADs regarding infection?

Surgical implantation sites and percutaneous drive lines create potential entry points for bacterial contamination

What is a significant hemorrhage complication concern with VADs?

Perioperative and postoperative bleeding, requiring blood transfusions due to anticoagulation therapy

Why are VAD patients at risk of thromboembolic events?

Blood clot formation within the device or associated vasculature poses ongoing risk

What is a neurological complication VAD patients have an elevated risk for?

Stroke, due to altered blood flow patterns and anticoagulation requirements

What should be done daily as part of CVAD maintenance protocol?

Inspect the insertion site for signs of infection (erythema, swelling, warmth, or purulent drainage)

What is the scope of practice for Primary Care Paramedics regarding CVAD flushing and maintenance?

It is outside their scope and requires advanced certification

What is the first key phase of a surgical implantation procedure for medical devices?

Preoperative Phase, involving comprehensive patient evaluation and informed consent

What happens during the "System Integration" phase of surgical implantation?

Meticulous connection of the device to relevant anatomical structures and comprehensive testing of device functionality

Why is remote device monitoring beneficial for VADs?

It allows real-time assessment of performance parameters and early intervention when abnormalities are detected

What kind of education is continuously provided to patients with implanted medical devices?

Device care, recognition of warning signs, and proper maintenance procedures

For hypotensive patients with a CVAD, what is the PCP protocol for IV fluid administration?

PCPs must establish peripheral IV access; CVADs cannot be utilized as first-line access

What should PCPs maintain a high index of suspicion for in patients with indwelling devices?

Systemic Inflammatory Response Syndrome (SIRS) and septic shock

What immediate action is required for hypovolemic emergencies caused by device dislodgement in VAD/CVAD patients?

Immediate transport and volume resuscitation

What is a mental health crisis consideration for PCPs encountering patients with implanted devices?

Be prepared for psychiatric emergencies involving intentional device manipulation or removal attempts for self-harm or suicide

What is a future development in implantable medical technology enabling real-time data transmission and remote monitoring?

Enhanced Connectivity (wireless communication capabilities)

What does AI (Artificial Intelligence) integration enable in future implantable medical technology?

Personalized treatment optimization through real-time data analysis and predictive algorithms

What type of battery development is improving device operational lifespan for implanted medical technology?

Revolutionary battery technology developments are significantly extending device operational lifespan

What is the goal of advanced biocompatible materials research for implanted devices?

Reducing rejection risk, improving long-term compatibility, and enhancing overall device performance and longevity

What is the benefit of device miniaturization in implantable medical technology?

Offering improved patient comfort and reduced surgical complexity

Why is early transport essential for cardiac arrest in VAD patients?

Due to significant hemorrhage risk if CPR is performed