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ACritical Care > 2 Hemodynamic Monitoring > Flashcards

2 Hemodynamic Monitoring Flashcards

1
Q

Cardiac output

(How to get the measurement)
What is it
Lab value

A

HR x SV = CO

Amount of blood pumped out of ventricle every minute

4-8L/min

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2
Q

Stroke volume

What is it

What is it affected by (also affects CO)

A

amount of blood ejected every time ventricles contract

Preload
Afterload
Contractility
HR (SV as well for CO)

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3
Q

Preload

Think what?
What is it
Too much volume in right ventricle can do what

A

Think: volume

Degree of ventricular stretch at end diastole

Too much volume (overload lungs (pushing onto lungs)

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4
Q

Afterload

Think what
What is it

A

Resistance

Pressure the ventricle must overcome to eject blood volume
(pushing against SVR)

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5
Q

Causes that:

Increase afterload

Decrease afterload

A

Increase: (constrict)
-HTN
-atherosclerosis
-aortic/pulmonary stenosis

Decrease: (dilate)
-sepsis
-anaphylaxis
-spinal cord injury

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6
Q

Contractility

What is it

What is it affected by

A

Force the heart needs to propel stroke volume forward into vasculature

Affected by Preload

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7
Q

Heart rate

Easy to manipulate with what?

How does elevated vs slow HR compromise CO
Fixing the HR wont what

A

Meds easily manipulate HR

Elevated: not letting ventricles relax to fill up
Slowed: not pumping it out fast enough

Fixing HR wont solve problem (need to find real issue)

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8
Q

CI (cardiac index)

A

A better assessment than CO

CI = CO/body surface area
(Done by computer)

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9
Q

SVR (systemic vascular resistance)
-what resistance
-how to get arterial BP

PVR (pulmonary vascular resistance)
-what resistance

A

SVR:
-peripheral vascular resistance
Arterial BP = CO x SVR

PVR:
-pulmonary resistance

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10
Q

Lab values to know

CO(cardiac output)
CI (cardiac index)

CVP (RAP) (central venous pressure/right heart pressure)

PAOP (wedge) = pulmonary artery occlusion pressure

A

CO: 4-8L/min

CI: 2.5-4.2L/min

CVP: 2-6 mmHg

PAOP (wedge): 8-12 mmHg

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11
Q

Noninvasive hemodynamic monitoring

A

NIBP (cuff)

JVD

Lactate levels

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12
Q

JVD

-indirect measurement of what?
So it occurs when what is elevated?

What can cause JVD?

A

Indirect measurement of CVP (right heart pressure)
-CVP elevated

Right sided HF can cause JVD

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13
Q

Lactate levels:

Help determine what?
Normal level
Elevated when what is going on?

How does we get a lactate level (what do we put it on)

A

Tissue hypoperfusion in shock)

0.5-1.6

Elevated:
-lactic acidosis
-sepsis

Draw blood: send on ice

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14
Q

Common diagnosis requiring invasive monitoring

A

Shock:
septic, hypovolemic, neurogenic, cardiogenic

Heart:
Cardiac tamponade, MI, Post-op major sx (CABG)

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15
Q

Arterial line
-measures what?
-location

Central venous catheter:
-measures what
-location

A

art line:
-BP
-radial/femoral

CVC:
-CVP
-IJ/SC

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16
Q

Pulmonary artery catheter
-via a what?
-location

A

Via a cordis (big line)

IJ/SC

17
Q

One arterial line is in

-position patient
-zeroing
-place transducer where
-how to prevent infection

A

HOB flat or elevated

Zeroing (to atomospheric pressure)

Phlebostatic axis

Sterile procedure putting it in

18
Q

Where is the phlebostatic axis

A

4th ICS (MCL)
(approximately at level of Right Atrium)

19
Q

Invasive catheter (CVC or A-line)

-placed by who
-complications
-what can nurse do

A

HCP

Complications:
-pneumothorax (if placed in neck or chest)
-infection (CLBSI)

Nurses can prime/set up pressure tubing

20
Q

What can happen if tubing is disconnected?

What if transducer is not zeroed or properly placed?

A

Exsanguination (bleeding)

Transducer:
-false readings

21
Q

Invasive catheter (CVC or Arterial line)

-inflate pressure bag to what?
-use what kind of fluid?

A

Inflate to 300mmHg

Use 0.9% NS

22
Q

Allens test

A

1.Make a fist
2.Compress both arteries in wrist (ulna and radial)
3.Let one go and see if blood flow returns

Checks to see patency of arteries

23
Q

Arterial line

Test we do
Armboard
Never do what through an arterial line?
When removing a a-line hold pressure how long

A

Allen’s test

Armboard (prevent from pulling it out)

Never administer meds in an A-line

Hold pressure for 5 mins

24
Q

A-line (square wave test)

Pull what?

Optimal waveform

Overdamped vs underdamped wave form

A

Pull pigtails (quick flush)

Optimal:
quick upstroke, plateau before returning to baseline

Overdamped:
Low upstroke (false reading)

Underdamped:
Tall wave (false reading)

25
Q

Dicrotic notch

(In arterial line wave form)
What does it mean

A

Good wave form

-closure of aortic valve

26
Q

RAP/CVP (right atrial pressure) (central venous pressure)

What is being measured?
Low vs high CVP

A

Direct measurement of pressure in right atrium
(Right side of heart)

Low CVP: shock state (give fluids) d/t low volume
High CVP: too much fluid (diuretics)

27
Q

*RAP/CVP
*TLC (triple lumen catheter)
-what color is the distal port (can you give meds?)
-what locations is it placed
*PA catheter
-what color is the right atrial port
(can you give meds?)

*How do we confirm placement of these catheters?

A

TLC:
-brown (distal port)
okay to admin meds through this CVP port
-SC or IJ vein

PA catheter:
-blue (right atrial port)
you can give meds through this port

Confirm placement of these lines with:
CXR

28
Q

Which CVP ports can you give meds?

A

TLC (distal BROWN/BLUE port):
You CAN give meds through

29
Q

Complications of RAP/CVP monitoring (catheters)

A

Infection
Carotid puncture
Pneumothorax/hemothroax

Heart perforation
Dysrhythmias

30
Q

Pulmonary artery catheters

Other name?

Measures what 2 things?
What we need to know it measures

A

SWAN

Measures:
-right sided heart pressures
-indirect measurement of left side heart
PAP (pulmonary artery pressure)

31
Q

PAP monitoring (PA catheter)

Can you give meds/fluids through these?
Blue- CVP/RAP
Yellow- PAP

Ballon: inflated to what?

A

Blue: okay to give meds

Yellow: never give meds/fluids through

Ballon: syringe 1.5ml

32
Q

Insertion of PA catheter

-position for insertion
-insert with ballon what?
2 ways to check proper placement

A

Position:
-trendelenburg (head down)
-towel roll between shoulder blades

Insert w/ ballon deflated

2:
-check for proper “wedging” for PAOP (wave forms)
-chest X-ray

33
Q

Know the difference wave forms for which heart locations for swan insertion progression?

A

Right atrial pressure

Right ventricular pressure

Pulmonary artery pressure (PAP)

Pulmonary artery wedge pressure (PAWP)

ACritical Care (8 decks)

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