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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
what does PAS tell us regarding CO? | What side of the heart
Afterload | Rt side
26
What is PAD
Diastolic pulmonary artery
27
What is the normal range for PAD what does it tell us about CO what side of the heart does the PAD represent
8-15 mmHg preload left
28
What is PCWP
pulmonary capillary wedge pressure
29
what is the normal range for PCWP what does it tell us about CO what side of the heart does it represent
8-12 mmHg Preload Left
30
What do CO and CI indirectly tell us regarding CO
contractility
31
What is the normal range of CI
2.5-4 L/min/m^2
32
what is the normal range for CO
4-8 L/min
33
What is SVR what is the normal range What does it tell us about CO what side of the heart
systemic vascular resistance 800-1400 dynes/sec/cm5 afterload left
34
what is normal SvO2 | what does it tell us
60-80% | oxygen supply and demand
35
What are some common complications of PA line insertion
pneuomothorax tamponade arrythmias
36
what position must patients be in for accurate measurements with PA lines
supine with HOB raised
37
what does the pulmonary artery pressure tell us
pressure of blood flow going to the lungs
38
When would you see increased PVR
increased in pulmoanry vasoconstriction such as COPD, pulm HTN, ARDs, PE
39
What does PCWP tell us
more accurate indciator of LV preload
40
What can be used as PCWP
PAD | but difference should be 1-4 mmHG greater in PAD
41
what does CI take into account compared to CO
body surface area
42
what does thermodilution calucate
how fast it takes for cooler blood to reach distal sensor in PA if contractility is decreased takes longer to get to sensor
43
what does the CO curve look like for high CO
quick peak and quick return to baseline small area under curve boluses move base thermistor quickly
44
what does the CO curve look like for low CO
lower peak over longer period big area under curve boluses mixes with blood and takes longer to move past thermistory
45
what is spontaneous wedging? | what are signs and symptoms that it has occured
PAC wedges into smaller artery branch and occludes blood will see spontaneous appearance of PCWP tracing prolonged wedge time requires prompt intervention
46
what will you observe if the pulmonary artery becomes ruptured or perforated
acute hemodynamic instability decrease in SaO2 bloody ETT secretions
47
who are most at risk for PA rupture or perforation
those with riable PA i.e. longstanding pulmonary HTN
48
how can you minimize the risk of PA rupture or perforation
avoid wedging correct placement avoid overinflation close observation during wedging and cessation of balloon inflation
49
What are 6 causes of a dampened waveform
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
what can cause PCWP to be unobtainable
ruptured balloon ->notify MRP incorrect cc of air in baloon -> deflate and re-inflate malposition--> MRP
51
What can cause spontaneous change in waveform from PA to PCWP (auto-wedge)
catheter wedged --> DB &C, change pt position notify MRP for reposition ensure baloon not inflated
52
RV waveform
cath slipped back into RV -> MRP
53
when baloon inflated wedge pressure drifts up/down on monitor
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
false low PA pressure values
tip of cath against wall --> flush or reposition transducer higher than phlebostatic axis --> reposition disconnected/loose tubing --> troubleshoot
55
false high PA pressure values
transducer lower than phlebostatic axis clotted catheter - aspirate clot catheter kinked under dressing
56
What value tell you rt sided preload? | left?
CVP/RA | PCWP, PAD
57
What value tell you afterload for the rt side? | left
PVR | SVR
58
What are treatments for high preload
diuretics/nitro
59
what are treatments for low preload
fluids
60
what are treatemnts for high afterload
vasodilators, nitric oxide, nipride, milrinone, dobutamine
61
what are treatments are for low afterload
domapine, levophed, epi, phenyl
62
what meds are given for high contractility
beta blocker | calcium channel blocker
63
what meds are given for low contractility
dopamine, epi, dobutamine, milrinone
64
what will RA be like in hypovolemic, cardiogenic and septic shock
hypovolemic: low cardiogenic: high septic: low
65
what will PCWP be in hypovolemic, cardiogenic and septic shock
hypovolemic: low cardiogenic: high septic: low
66
what will CO be in hypovolemic, cardiogenic and septic shock
hypovolemic: low cardio: low septic: low
67
what will CI be in hypovolemic, cardiogenic and septic shock
hypovolemic: low cardio: low septic: low
68
what will SVR be in hypovolemic, cardiogenic and septic shock
hypovolemic: high cardiogenic: high septic: low

NSCC 7520 Critical Care Theory 4 (5 decks)

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