2 Hemodynamic Monitoring Flashcards
Cardiac output
(How to get the measurement)
What is it
Lab value
HR x SV = CO
Amount of blood pumped out of ventricle every minute
4-8L/min
Stroke volume
What is it
What is it affected by (also affects CO)
amount of blood ejected every time ventricles contract
Preload
Afterload
Contractility
HR (SV as well for CO)
Preload
Think what?
What is it
Too much volume in right ventricle can do what
Think: volume
Degree of ventricular stretch at end diastole
Too much volume (overload lungs (pushing onto lungs)
Afterload
Think what
What is it
Resistance
Pressure the ventricle must overcome to eject blood volume
(pushing against SVR)
Causes that:
Increase afterload
Decrease afterload
Increase: (constrict)
-HTN
-atherosclerosis
-aortic/pulmonary stenosis
Decrease: (dilate)
-sepsis
-anaphylaxis
-spinal cord injury
Contractility
What is it
What is it affected by
Force the heart needs to propel stroke volume forward into vasculature
Affected by Preload
Heart rate
Easy to manipulate with what?
How does elevated vs slow HR compromise CO
Fixing the HR wont what
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)
CI (cardiac index)
A better assessment than CO
CI = CO/body surface area
(Done by computer)
SVR (systemic vascular resistance)
-what resistance
-how to get arterial BP
PVR (pulmonary vascular resistance)
-what resistance
SVR:
-peripheral vascular resistance
Arterial BP = CO x SVR
PVR:
-pulmonary resistance
Lab values to know
CO(cardiac output)
CI (cardiac index)
CVP (RAP) (central venous pressure/right heart pressure)
PAOP (wedge) = pulmonary artery occlusion pressure
CO: 4-8L/min
CI: 2.5-4.2L/min
CVP: 2-6 mmHg
PAOP (wedge): 8-12 mmHg
Noninvasive hemodynamic monitoring
NIBP (cuff)
JVD
Lactate levels
JVD
-indirect measurement of what?
So it occurs when what is elevated?
What can cause JVD?
Indirect measurement of CVP (right heart pressure)
-CVP elevated
Right sided HF can cause JVD
Lactate levels:
Help determine what?
Normal level
Elevated when what is going on?
How do we get a lactate level (what do we put it on)
Tissue hypoperfusion in shock)
0.5-1.6
Elevated:
-lactic acidosis
-sepsis
Draw blood: send on ice
Common diagnosis requiring invasive monitoring
Shock:
septic, hypovolemic, neurogenic, cardiogenic
Heart:
Cardiac tamponade, MI, Post-op major sx (CABG)
Arterial line
-measures what?
-location
Central venous catheter:
-measures what
-location
art line:
-BP
-radial/femoral
CVC:
-CVP
-IJ/SC
Pulmonary artery catheter
-via a what?
-location
Via a cordis (big line)
IJ/SC
One arterial line is in
-position patient
-zeroing
-place transducer where
-how to prevent infection
HOB flat or elevated
Zeroing (to atomospheric pressure)
Phlebostatic axis
Sterile procedure putting it in
Where is the phlebostatic axis
4th ICS (MCL)
(approximately at level of Right Atrium)
Invasive catheter (CVC or A-line)
-placed by who
-complications
-what can nurse do
HCP
Complications:
-pneumothorax (if placed in neck or chest)
-infection (CLBSI)
Nurses can prime/set up pressure tubing
What can happen if tubing is disconnected?
What if transducer is not zeroed or properly placed?
Exsanguination (bleeding)
Transducer:
-false readings
Invasive catheter (CVC or Arterial line)
-inflate pressure bag to what?
-use what kind of fluid?
Inflate to 300mmHg
Use 0.9% NS
Allens test
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
Arterial line
Test we do
Armboard
Never do what through an arterial line?
When removing a a-line hold pressure how long
Allen’s test
Armboard (prevent from pulling it out)
Never administer meds in an A-line
Hold pressure for 5 mins
A-line (square wave test)
Pull what?
Optimal waveform
Overdamped vs underdamped wave form
Pull pigtails (quick flush)
Optimal:
quick upstroke, plateau before returning to baseline
Overdamped:
Low upstroke (false reading)
Underdamped:
Tall wave (false reading)
