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Anesthesia > Arterial Catheterization & Direct Blood Pressure Monitoring > Flashcards

Arterial Catheterization & Direct Blood Pressure Monitoring Flashcards

1
Q

What is arterial blood pressure a product of? What does it provide?

A

cardiac output and systemic vascular resistance

hydraulic force that drives blood flow and affects tissue perfusion

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2
Q

What is direct arterial blood pressure monitoring? What are 6 indications?

A

gold standard measuring of BP - arterial cannulation with continuous pressure waveform display giving continuous real-time monitoring

  1. rapid, moment-to-moment BP changes are anticipated
  2. failure of indirect BP monitoring
  3. when higher accuracy of BP tracing is desired
  4. exact patient responsiveness with the use of vasopressors
  5. evaluation of respirophasic variations in arterial pressure waveform to predict fluid responsiveness
  6. when NIBP performed repetitively may injure tissues
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3
Q

What may cause failure of indirect BP monitoring?

A
  • morbit obesity
  • extremity injuries
  • chondrodystrophy
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4
Q

What are 4 advantages to direct arterial blood pressure monitoring?

A
  1. continuous monitoring
  2. considered very accurate
  3. real-time display
  4. allows for arterial sampling
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5
Q

What are 4 disadvantages to direct arterial blood pressure monitoring?

A
  1. complications and risks
  2. training required
  3. expensive
  4. time intensive
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6
Q

What are 3 contraindications to arterial catheterization?

A
  1. coagulopathy
  2. dermatitis
  3. absence of collateral circulation
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7
Q

What are 6 things that make problems following arterial catheterization more likely?

A
  1. thromboembolic potential
  2. large catheter size
  3. low cardiac output to begin with
  4. vasculitis
  5. poorly perfused local tissues
  6. potent vasopressors
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8
Q

Why is invasive blood pressure monitoring important?

A
  • Doppler can be unreliable for detecting hypotension
  • Doppler and oscillometric methods may underestimate all BP parameters due to cuff placement sites and the device itself
  • poor agreement between Doppler and invasive measurements in patients weighing less than 5 kg
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9
Q

What are the 2 preferred sites for the insertion of arterial catheters in equine patients?

A
  1. transverse facial artery
  2. linguofacial artery
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10
Q

What are the 4 preferred sites for the insertion of arterial catheters in small animal patients?

A
  1. dorsal pedal (metatarsal) artery
  2. femoral artery
  3. radial artery
  4. ventral sacral / coccygeal artery
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11
Q

How does recumbency alter measurements of direct arterial blood pressure?

A

dorsal and lateral recumbency results in higher measurements in hindlimbs compared to carpal measurements

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12
Q

How do tail direct arterial blood pressure measurements compare in cats?

A

tail measurements tend to be higher than radial measurements

  • so much so that the discrepancies were high enough to affect treatment decisions
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13
Q

What 5 common complications are associated with direct blood pressure monitoring?

A
  1. potential for hemorrhage
  2. arterial embolization potential
  3. infection
  4. ischemia
  5. limited movement for patient required
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14
Q

What are the 4 major components of an invasive blood pressure monitoring system?

A
  1. patient catheter interface
  2. transducer
  3. infusion and/or flushing system
  4. monitor
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15
Q

What is part of the checklist for invasive blood pressure monitoring?

A
  • arterial cannula/catheter
  • non-constricting tape
  • Tegaderm - transparent film dressing with adhesive-free window
  • Emla (lidocaine/prilocaine), 4% lidocaine cream
  • short, stiff fluid tubing
  • heparinized saline flush
  • transducer with 3-way stopcocks
  • multiparameter monitor capable of invasive pressure readings
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16
Q

How does the invasive blood pressure monitoring system work?

A
  • column of saline in the arterial set transmits pressure changes to the membrane in the transducer
  • membrane is able to sense flucuations and the transducer changes fluctuations into an electrical signal
  • electrical signal is then converted to waveform and scale on display
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17
Q

What kind of tubing is required for direct blood pressure monitoring?

A

noncompliant, stiff tubing —> movement alters readings!

18
Q

How is the blood pressure reading altered by the incorrect placement of the air-fluid (transducer) interface?

A

BELOW CATHETER TIP = weight of the fluid on the transducer diaphragm adds to the intravascular or intracardiac

ABOVE CATHETER TIP = decreased displayed intravascular or intracardiac pressure

19
Q

How is arterial catheterization performed?

A
  • site checked ofr collateral circulation
  • site is clipped and topically numbed with Emla or 4% lidocaine
  • keep site warm with a saline gauze pad
  • catheter is primed with heparinized saline
  • palpate pulse proximally with 2 fingers
  • insert at 15-30 degrees at the dorsal pedal artery or 45-90 degrees at the femoral artery
  • when blood is seen, feed the catheter off the stylet, cap, and flush immediately
  • secure with tape and attach tubing, then check for.a waveform
20
Q

How does insertion of an arterial catheter compare to a venous one?

A

ARTERIAL = short, forward, abrupt attempts

VENOUS = slow advancement

21
Q

Direct arterial blood pressure waveforms:

A
22
Q

What is natural frequency?

A

LV ejection initiates a pressure wave that is propagated down the aorta toward the periphery, forming the original pressure wave that is equal to the pulse rate

23
Q

What are 3 changes that affect natural frequency?

A
  1. DAMPENING - prevents a system from overshooting after responding to a change, particularly at frequencies close to the natural frequency of the system
  2. OVERDAMPENING - inhibited natural frequency
  3. UNDERDAMPENING - uninhibited natural frequency (resonance, ringing)
24
Q

How does overdampening appear as a waveform? What are 4 causes of this?

A

slurred upstroke, absent dicrotic notch, and loss of fine detail

  1. blood clots
  2. air bubbles in tubing or injection ports
  3. severe hypotension
  4. kinked catheters
25
Q

How does overdampening affect direct BP measuring?

A
  • underestimates SBP
  • overestimates DBP
26
Q

How does underdampening (resonance) appear as a waveform? What are 5 causes?

A

exaggerated peaks and troughs

  1. long connecting lines
  2. small diameter tubing
  3. stiff tubing
  4. increased vascular resistance
  5. catheter occludes vessel
27
Q

How does underdampening (resonance) affect direct BP measurement?

A
  • overestimated SBP
  • underestimated DBP
28
Q

How can the natural frequency of direct blood pressure monitoring be optimized?

A
  • use wide bore, high pressure tubing no longer than 122 cm (48 in)
  • avoid tubing extensions and minimize stopcocks
  • ensure that all connections are tightened
  • eliminate air from the flush fluid and air bubbles from the tubing system
  • keep continuous flush bag filled and keep external pressure cuff at 300 mmHg
  • use continuous flush device to prevent clotting
  • keep cannulated extremity in a neutral or slightly extended position to prevent catheter kinking
29
Q

How is the fast flush test used to analyze natural frequency?

A

OPTIMALLY DAMPENED = 1.5-2 oscillations before returning to tracing, values obtained are accurate

UNDERDAMPENED = >2 oscillations, overestimated systolic pressure and underestimated diastolic pressure

OVERDAMPENED = <1.5 oscillations, underestimated systolic pressure and overestimated diastolic (or not affected)

30
Q

Where is arterial blood pressure sampling performed in the catheter? How?

A

at the catheter, NOT the transducer

  • withdraw and small sample first and discard
  • flush immediately with 1-2 U of heparin mer mL of saline post-sample
31
Q

How is the direct arterial catheter flushed?

A

post-transducer, NOT across

  • ensure all connections are tight and that there are no air bubbles in line
32
Q

What should be checked if the direct blood pressure trace is lost?

A
  • Is the catheter clotted?
  • Is the artery spasmed? Is the leg cool or warm? Is the patient on pressors?
  • Is the dressing or tape too tight?
  • Is the catheter kinked on entry?
  • Did the scale change?
  • Did the cable come loose?
33
Q

What is important to include for continued cate of arterial catheters?

A
  • labelling, wrapping, bandaging (especially with vasopressors)
  • direct connection vs. needle
  • cleanly handling
  • heparinization
  • pulse, color or extremity
  • watch for hemorrhage
  • stillness/sedation of patient
  • potential for chewing
34
Q

What are some complications of arterial catheterization?

A
  • ischemia
  • hemorrhage
  • thrombosis and vasospam
  • extravessel hematoma/neuropathy
  • embolism - air, clot
  • aneurysm formation
  • inadvertent injection of drugs especially with pressors
  • arteriovenous fistula formation
  • skin necrosis
  • infection - stopcocks!
35
Q

What are important check points near the catheter?

A
  • irritation, focus, or tenderness
  • motion
  • skin color
  • warmth, lack of warmth
  • swelling
  • discharge
  • lack of pulse
36
Q

How are arterial catheters removed?

A
  • wear PPE
  • detach the arterial pressure monitoring line and cap the catheter
  • get sterile gauze pad and wrap ready
  • withdraw the catheter quickly and gently, keeping it parallel to the skin
  • wrap injection site
  • no wiping!
  • wrap removal after 10 mins
37
Q

A blood pressure transducer changes _______ based on a strain gauge principle.

a. electric signal to arterial waveforms
b. fluctuations in a membrane to electrical signals
c. arterial waveforms to ECG signals
d. light waves to pulse oximetry waves

A

B

38
Q

All of the following are sites of possible arterial cannulation in the small animal patient EXCEPT:

a. carotid artery
b. dorsal pedal, or dorsal metatarsal artery
c. femoral artery
d. ventral coccygeal artery

A

A

39
Q

Complications of invasive blood pressure measurement include…

a. ischemia
b. embolization
c. infection
d. all of the above

A

D

40
Q

All of the following are advantages of direct blood pressure monitoring in small animal patients EXCEPT…

a. it allows continuous pressure measurement
b. considered highly accurate, a gold standard
c. easy and safe for the patient
d. allows real-time display of an arterial waveform

A

C

41
Q

Common reasons for loss of a blood pressure tracing on a monitor include…

a. blood clots within the arterial catheter
b. vasodilation
c. air embolism
d. apnea

A

A

Anesthesia (40 decks)

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