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PMI > Arterial Lines > Flashcards

Arterial Lines Flashcards

1
Q

2 purposes of arterial lines

A
  1. provide a real time blood pressure

2. arterial lines provide constant access blood samples to send for lab results

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2
Q

what is the catheter size for radial/brachial used for adults?

A

20 ga

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3
Q

what is the catheter size for femoral used for adults?

A

18 ga

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4
Q

what is the catheter size for pediatrics

A

20-22 ga

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5
Q

what is the catheter size for used for neonates?

A

22-24 ga

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6
Q

automatic bp machines tend to __(under read or over read) systolic bp and tend to ___ (under read or over read) diastolic bp

A

under read; over read

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7
Q

arterial lines which is most likely to be elevated?

A

systolic bp

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8
Q

Name the 5 materials for the pressure transducer system

A
  1. 500 ml NS bag
  2. arterial line tubing (noncompliant tubing) that contains a pressure transducer
  3. pressure transducer cable
  4. pressure bag for 500 ml NS bag
  5. transducer holder
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9
Q

what does the transducer do?

A

tells you how many mm Hg are generated with each pulse

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10
Q

why use heparinized saline?

A

system less likely to clot

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11
Q

what would happen if you did not use a pressurized bag ?

A

blood from the artery would back up into the tubing

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12
Q

what is the purpose of pressurized bag?

A

when the 500 mL NS is pressurized it exceeds arterial pressure and ALLOWS TO FLUSH FLUID INTO ARTERY

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13
Q

how do you flush an arterial line?

A

open the roller clamp and compressing the wings on the transducer

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14
Q

when should you flush fluids into an artery?

A

immediately after drawing blood labs from arterial line

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15
Q

what could happen if drugs are given the arterial route?

A

intense vasoconstriction and ischemia

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16
Q

what are the 4 possible reasons an arterial line wont flush?

A
  1. the stopcocks could be turned off to the line
  2. the pressure bag is under pressurized
  3. the roller clamp on the aline tubing could be closed
  4. the aline catheter could be clotted off
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17
Q

what pressure should the bag be pressurized?

A

300 mm Hg

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18
Q

how much fluid per hour will drip into the artery?

A

3-6 mL

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19
Q

what is the purpose of zeroing the arterial line?

A

eliminating the effect of atmospheric pressure has on bp reading

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20
Q

what should you change on the monitor for zeroing the transducer?

A

change from standard to arterial line tracing 8 wave

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21
Q

what could happen if the stopcock is turned the wrong direction off towards the transducer instead of patient?

A

it will bleed back and the pt could bleed to death

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22
Q

what should you do once the monitor shows a 0?

A

turn the stopcock off to the atmosphere again THEN put cap back on stopcock

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23
Q

7 things required for cannulating the artery

A
  1. chloraprep
  2. gauze
  3. tegaderm
  4. tape
  5. plastic “wrist support”
  6. lidocaine “skin wheel”
  7. angiocath
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24
Q

what are the two catheter options for cannulating the artery?

A
  1. 20 ga arrow catheter

2. 20 ga regular catheter

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25
Q

2 options for an Aline wrist extender

A
  1. plastic “wrist support”

2. rolled up towel under the wrist

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26
Q

how do you calculate MAP with a line waveform?

A

area under the pressure curve

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27
Q

correlates with cardiac contractility

A

upstroke

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28
Q

what indicates good cardiac contractility?

A

sharp vertical upstroke

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29
Q

correlates with SVR

A

downstroke

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30
Q

a slow fall or high SVR indicates ___

A

vasoconstriction

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31
Q

a sharp fall or low SVR indicates ____

A

vasodilation

32
Q

why do you see a dichrotic notch on the A line waveform?

A

closing of AORTIC valve

33
Q

more sluggish upstroke and downstroke indicates ___ and ___

A

lower contractility and higher SVR

34
Q

steeper upstroke and downstroke indicate ____ and ____

A

higher contractility and lower SVR

35
Q

what does a dampened waveform mean?

A

gives inaccurate bp; underestimates the systolic BP (makes you think systolic bp is lower than it really is) and overestimates the diastolic bp while the MAP is unchanged

36
Q

5 causes of dampened waveform

A
  1. compliance in the tubing
  2. a partially clotted off catheter
  3. a kinked catheter from a flexed wrist
  4. low pressure in the system
37
Q

how do you fix a dampened a line waveform ? (4)

A
  1. try to aspirate the blood and/or flush the tubing
  2. try extending the wrist
  3. make sure the system is pressurized to 300 mm Hg
  4. look for air and aspirate any air bubbles
38
Q

before treating hypotension you have to make sure of what two things?

A
  1. the low bp reading is not due to a dampened waveform

2. the transducer is appropriately leveled

39
Q

3 effects of underdamped waveform

A
  1. an overestimation of systolic bp
  2. an underestimation of diastolic bp
  3. MAP is unchanged
40
Q

6 causes of an underdamped waveform

A
  1. a defective transducer
  2. tachycardia
  3. long tubing
  4. movement of catheter inside the artery
  5. a catheter that is too large for vessel
  6. increased vascular resistance
41
Q

in an optimally damped waveform when does the wave return to baseline?

A

after one oscillation

42
Q

in an underdamped waveform how often does the wave oscillate before returning to baseline?

A

oscillated multiple times

43
Q

when the wave returns to baseline without any oscillations what waveform is this characteristic of?

A

overdamped waveform

44
Q

term used when an arterial line system is pressurized it oscillates at a certain frequency

A

natural or resonant frequency

45
Q

the fundamental frequency is equal to __

A

pulse rate

46
Q

what is the fundamental frequency when the heart rate is 60 beats per minute?

47
Q

what is the fundamental frequency when the heart rate is 120 beats per minute?

48
Q

the fundamental frequency of an a line waveform should normally be between ___ and ___ Hz

49
Q

the natural frequency is how much more than the fundamental frequency?

50
Q

when two or more waves of similar frequency coincide to produce a single wave with a higher peak amplitude

A

constructive interference

51
Q

when the wave gets bigger because b/c external FORCE with a similar frequency was applied to it

52
Q

what becomes a factor if the natural frequency and fundamental frequency are similar?

53
Q

when is resonance more likely?

A

decrease in natural frequency or increase in fundamental frequency

54
Q

what can counteract resonance?

55
Q

how can you measure the amount of damping?

A

damping coefficient or damping ratio

56
Q

a high damping coefficient= ___ waveform

57
Q

name the arterial line cannulation sites

A
  1. radial arterial line
  2. ulnar arterial line
  3. brachial arterial line
  4. axillary arterial line
  5. femoral arterial line
  6. dorsalis pedis and posterior tibial (most distal)
58
Q

what is the most common and preferred arterial cannulation site?

A

radial arterial line

59
Q

<7 seconds time for blood to return to hand

A

positive allen’s test; adequate collateral circulation

60
Q

8-15 seconds time for blood to return to hand

A

uncertain; questionable allen’s test

61
Q

> 15 seconds time for blood to return to hand

A

negative allen’s test; inadequate collateral circulation

62
Q

carries the highest risk of cerebral emboli

A

axillary arterial line

63
Q

an embolus from an axillary arterial line is more likely to enter cerebral circulation through what side?

64
Q

What are the complications for femoral lines? (3)

A
  1. a hole in the back of the femoral artery
  2. possible femoral nerve damage
  3. potentially higher infection rates
65
Q

which arterial site gives the highest systolic BP, lower diastolic, and lower mean BP readings and dampened wave form ?

A

distal; dorsalis pedia/posterior tibial

66
Q

5 complications from arterial line complications

A
  1. limb ischemia
  2. neurologic injury
  3. infection
  4. hemorrhage
  5. misinterpretation of data
67
Q

the pressure of the artery at the base of the foot in a person who is standing is how much higher than the top of the head?

68
Q

when will gravity or hydrostatic pressure affect blood pressure readings?

A

anytime pt is NOT lying flat

69
Q

located at the 4th intercostal space along the mid axillary line

A

phlebostatic axis

70
Q

phlebostatic axis represents the external location of ___

A

right atrium

71
Q

where is central venous pressures not influences by hydrostatic pressures?

A

phlebostatic axis

72
Q

where should bp readings be taken?

A

at the level of the heart

73
Q

what will happen if the transducer is below the level of the heart?

A

overestimates blood pressure

74
Q

what will happen if the transducer is above the level of the heart?

A

underestimates the blood pressure

75
Q

how much does the fluid pressure increase if the transducer is below the tip of the catheter?

A

1.87 mm Hg

76
Q

for sitting pts where should the transducer be placed ?

A

external auditory meatus

77
Q

how much does the pressure in the transducer increase when raising the arm? what is unchanged?

A

15 cm H20; overall bp reading at the transducer unchanged

PMI (21 decks)

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