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NSCC 7520 Critical Care Theory 4 > Advanced Hemodynamics > Flashcards

Advanced Hemodynamics Flashcards

1
Q

What types of patients are a PA line indicated for

A

evaluation of cardiogenic shock
post-op cardiac patients
heart failure patients

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2
Q

what type of catheter is a PA line, what is most frequently used

A

thermodilution catheter

7.0F, 4 lumen

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3
Q

what is oximetric in terms of PA caths

A

fiberoptic strand that extends from tip

attaches to specific monitor and allows continuous monitoring of SvO2

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4
Q

how much air is in the PA baloon

A

1.5 cc of air

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5
Q

when is the PA balloon inflated

A

to facilitate insertion

to obtain PCWP

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6
Q

What is the termistor connector

A

connects to monitor for CO measurements

calculates measurements based on temperature change of room air vs. temp in pulm artery

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7
Q

What color is the distal port on a PA line

A

yellow

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8
Q

what is the distal port in a PA line used for and where is it located

A

pulmonary artery
PA pressures
obtaining blood sample (SvO2)
patency maintained by pressurized NS infusion

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9
Q

can you use the distal port on a PA line for medications

A

Never

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10
Q

what color is the proximal port on a PA line and what can it be used for

A 
blue
opens in rt atrium 
used for IV infusions 
CVP measurements
fluid injection for CO determinants
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11
Q

At what length is the proximal port

A

30 cm

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12
Q

what sites can a PA line be inserted

A

subclavian
jugular
femoral

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13
Q

what is a PA line inserted through

A

cordis

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14
Q

what position must the pt be in during PA line insertion

A

trendelenberg

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15
Q

when is the balloon inflated on insertion

what will you see regarding pressure monitoring

A

Rt atrium ~ 30 cm mark

visualize a low threshold, bumpy waveform

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16
Q

what are 3 benefits of inflated baloon

A

prevents damage
softens tip
decreases risk of ventricular irritablity

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17
Q

What waveform will you see as the PA cath travels through the tricuspid valve into the rt ventricle

A

high threshold like mountains

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18
Q

can you see ventricular irritablity when the PA cath is in the rt ventricle

A

yes

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19
Q

what waveform do you see when the PA line is in the pulmonary artery

A

peaks with dichrotic notch (art line)

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20
Q

What does a CVP tell you about CO

What is the normal range

A

preload

2-6 mmHg

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21
Q

which side of the heart does the CVP tell you about

A

Right

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22
Q

What is normal pressure in the RV and when is it seen

A

20-30/0-6

only seen during insertion

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23
Q

What is the normal pressure for PAS

A

20-30 mmHg

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24
Q

what does PAS stand for

A

systolic pulmonary artery

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25
Q

what does PAS tell us regarding CO?

What side of the heart

A

Afterload

Rt side

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26
Q

What is PAD

A

Diastolic pulmonary artery

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27
Q

What is the normal range for PAD
what does it tell us about CO
what side of the heart does the PAD represent

A

8-15 mmHg
preload
left

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28
Q

What is PCWP

A

pulmonary capillary wedge pressure

29
Q

what is the normal range for PCWP
what does it tell us about CO
what side of the heart does it represent

A

8-12 mmHg
Preload
Left

30
Q

What do CO and CI indirectly tell us regarding CO

A

contractility

31
Q

What is the normal range of CI

A

2.5-4 L/min/m^2

32
Q

what is the normal range for CO

A

4-8 L/min

33
Q

What is SVR
what is the normal range
What does it tell us about CO
what side of the heart

A

systemic vascular resistance
800-1400 dynes/sec/cm5
afterload
left

34
Q

what is normal SvO2

what does it tell us

A

60-80%

oxygen supply and demand

35
Q

What are some common complications of PA line insertion

A

pneuomothorax
tamponade
arrythmias

36
Q

what position must patients be in for accurate measurements with PA lines

A

supine with HOB raised

37
Q

what does the pulmonary artery pressure tell us

A

pressure of blood flow going to the lungs

38
Q

When would you see increased PVR

A

increased in pulmoanry vasoconstriction such as COPD, pulm HTN, ARDs, PE

39
Q

What does PCWP tell us

A

more accurate indciator of LV preload

40
Q

What can be used as PCWP

A

PAD

but difference should be 1-4 mmHG greater in PAD

41
Q

what does CI take into account compared to CO

A

body surface area

42
Q

what does thermodilution calucate

A

how fast it takes for cooler blood to reach distal sensor in PA
if contractility is decreased takes longer to get to sensor

43
Q

what does the CO curve look like for high CO

A

quick peak and quick return to baseline
small area under curve
boluses move base thermistor quickly

44
Q

what does the CO curve look like for low CO

A

lower peak over longer period
big area under curve
boluses mixes with blood and takes longer to move past thermistory

45
Q

what is spontaneous wedging?

what are signs and symptoms that it has occured

A

PAC wedges into smaller artery branch and occludes blood
will see spontaneous appearance of PCWP tracing
prolonged wedge time
requires prompt intervention

46
Q

what will you observe if the pulmonary artery becomes ruptured or perforated

A

acute hemodynamic instability
decrease in SaO2
bloody ETT secretions

47
Q

who are most at risk for PA rupture or perforation

A

those with riable PA i.e. longstanding pulmonary HTN

48
Q

how can you minimize the risk of PA rupture or perforation

A

avoid wedging
correct placement
avoid overinflation
close observation during wedging and cessation of balloon inflation

49
Q

What are 6 causes of a dampened waveform

A

air in monitoring system –> flush
blood in tubing –> flush
clot in system –> aspirate DO NOT FLUSH, MRP
kinked catheter, wedged, wrong pos –> have pt cough, flush, check xray
loose conections –> tighten

50
Q

what can cause PCWP to be unobtainable

A

ruptured balloon ->notify MRP
incorrect cc of air in baloon -> deflate and re-inflate
malposition–> MRP

51
Q

What can cause spontaneous change in waveform from PA to PCWP (auto-wedge)

A

catheter wedged –> DB &C, change pt position
notify MRP for reposition
ensure baloon not inflated

52
Q

RV waveform

A

cath slipped back into RV -> MRP

53
Q

when baloon inflated wedge pressure drifts up/down on monitor

A

balloon overinflated ->when waveform changes form PA to wedge stop inflating
catheter not in far enough -> MRP
transducer incorrectly connected or not open to pt –> check and correct

54
Q

false low PA pressure values

A

tip of cath against wall –> flush or reposition
transducer higher than phlebostatic axis –> reposition
disconnected/loose tubing –> troubleshoot

55
Q

false high PA pressure values

A

transducer lower than phlebostatic axis
clotted catheter - aspirate clot
catheter kinked under dressing

56
Q

What value tell you rt sided preload?

left?

A

CVP/RA

PCWP, PAD

57
Q

What value tell you afterload for the rt side?

left

A

PVR

SVR

58
Q

What are treatments for high preload

A

diuretics/nitro

59
Q

what are treatments for low preload

A

fluids

60
Q

what are treatemnts for high afterload

A

vasodilators, nitric oxide, nipride, milrinone, dobutamine

61
Q

what are treatments are for low afterload

A

domapine, levophed, epi, phenyl

62
Q

what meds are given for high contractility

A

beta blocker

calcium channel blocker

63
Q

what meds are given for low contractility

A

dopamine, epi, dobutamine, milrinone

64
Q

what will RA be like in hypovolemic, cardiogenic and septic shock

A

hypovolemic: low
cardiogenic: high
septic: low

65
Q

what will PCWP be in hypovolemic, cardiogenic and septic shock

A

hypovolemic: low
cardiogenic: high
septic: low

66
Q

what will CO be in hypovolemic, cardiogenic and septic shock

A

hypovolemic: low
cardio: low
septic: low

67
Q

what will CI be in hypovolemic, cardiogenic and septic shock

A

hypovolemic: low
cardio: low
septic: low

68
Q

what will SVR be in hypovolemic, cardiogenic and septic shock

A

hypovolemic: high
cardiogenic: high
septic: low

NSCC 7520 Critical Care Theory 4 (5 decks)

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