3. Arterial Line

Question 1

Indications of Arterial Line

Answer 1

1. Beat to Beat blood pressure monitoring

Allow instant evaluation of CV response:
deterioration
Inotropic
Vasopressor Rx
Sedation admin

2. NIBP inaccurate / unreliable
   - arrhythmia / obesity
3. Serial ABG measures
   routine bloods FBC/ U+E/ Coag
4. CO monitors

Question 2

Complications

Answer 2

1. Bleeding
   - signif if femoral & RP haematoma
2. Haematoma following puncture
3. Distal Ischaemia
   = necrosis
   *accidental drug injection
4. Infection
5. Retrograde embolic phenomenon
6. AV fistula
7. Compartment Syndrome
8. Damage to adjacent structures
9. Exsanguination following disconnect
10. Stenosis of vessel lumen

Question 3

Information from Waveform

vitals

Answer 3

1. HR
2. Peak Systolic pressure
3. Diastolic pressure
4. MAP
   preferable as end point titrating inotrope or vasopressors

Question 4

Information from wave form

volume

Answer 4

5. SPV or art trace wing in MV
   - exag variation = hypovolaemia
6. Hypovolaemia indicated low dicrotic notch
7. SV
   AUC under systolic part waveform
   pulse contour analysis

Question 5

Information from waveform pressure

Answer 5

8 Slope of upstroke = myocardial contractility
systolic time interval or rate of change of pressure per unit time (DP/DT)
inversely proportional to contractility

9 Slope downstroke
- diastolic decay
idea of SVR
Slow fall indicates vasoconstriction
sharp fall = vasodilation

10. Certain valve disease states suggested
    Wide pulse pressure AR
    Slowed upstroke in stenosis

Question 6

b