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Arterial Lines Flashcards

1
Q

arterial line definition

A

like an IV but catheter inside artery

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2
Q

why are arterial lines more dangerous

A

if tubing is disconnected the patient could rapidly bleed to death

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3
Q

2 purposes for arterial lines

A

provide real time blood pressure

provide constant acess to blood samples for labs

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4
Q

catheter size used for adults arterial line

radial/brachial & femoral

A

20ga radial/brachial

18ga femoral

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5
Q

catheter size for pediatrics

A

20-22ga

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6
Q

catheter size for neonates

A

22-24ga

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7
Q

NIBP vs arterial line

A

NIBP tend to underread systolic and overread diastolic in comparison

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8
Q

what is the gold standard for BP?

A

arterial line

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9
Q

5 parts of a transducer system?

A 
500mL bag of N/S
arterial line tubing with pressure transducer
pressure transducer cable
pressure bag for the N/S
transducer holder
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10
Q

what does the transducer do?

A

tells us how many mmHg are generated with each pulse

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11
Q

why use N/S vs why use heparinized saline?

A

N/S: less possibility of heparin induced thrombocytopenia

heparinized: less chance for aline to clot off

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12
Q

purpose of the pressure bag

A

prevent blood backup into the tubing bc arterial blood pressures are high
allows us to flush fluid into artery

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13
Q

how to flush arterial line

A

compressing the two doodads (or tail) on the transducer and opening roller clamp

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14
Q

Why should drugs/air bubbles never be given via the arterial route?

A

they can cause intense vasoconstriction and ischemia

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15
Q

what are the 4 reasons that an arterial line will not flush?

A

stopcocks turned off to the line
pressure bag underpressurized
roller clamp could be closed
aline clotted off

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16
Q

what should be done if an aline clots off?

A

try to aspirate the clot

then try to flush

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17
Q

4 steps of setting up an aline

A

1-set up bag and pressurize to 300mmHg
2- flush to remove air
3-connect the cable to the monitor
4-zero the a line

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18
Q

Why do you inflate the pressure bag to 300mmHg?

A

no backflow of blood

3-6mL/hr drip into artery to prevent clot

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19
Q

when we zero an aline what are we eliminating?

A

the effect of atmospheric pressure

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20
Q

4 steps to zeroing an aline

A

1-change monitor to from standard to 8 wave
2-turn stopsock nearest to transducer OFF to the patient and open to air (cap removed)
3- touch the ABP and push zero on monitor
4- after it shows zero turn stopcock off to atmosphere THEN put cap back on

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21
Q

why does caution need to be taken with where the stopcock is turned?

A

if it is off to the transducer then the patient could bleed to death

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22
Q

why do you put the cap on the stopcock after you turn the stopcock?

A

putting it on before could introduce pressure into the system

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23
Q

What are the materials needed for cannulating the artery?

A 
chloraprep
4x4
tegaderm
tape
wrist support
lidocaine (if awake)
angiocath
(biopatch??)
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24
Q

2 catheter options for cannulating artery

A

20ga arrow catheter

regular 20ga catheter

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25
2 options for wrist extenders
rolled up towel | plastic support
26
6 steps to aline placement
``` 1- set up system and zero 2- position and prep 3- numb the area (if awake) 4-puncture artery and advance catheter 5- remove needle and attach 6- secure with tegaderm and tape ```
27
upstroke of a line
systole | correlates with cardiac contractility
28
downstroke of a line
diastole | correlates with SVR
29
how is MAP calculated aline
integrating the area under the pressure curve
30
sloped upstroke vs sharp upstroke
SLOPED: poorer contractility SHARP: good contractility
31
slow fall downstroke vs sharp fall downstroke
SLOW: vasoconstriction (high SVR) SHARP: vasodilation (low SVR)
32
dichrotic notch
blood slams into the aortic valve and then is projected forward
33
dampened waveform definition
smoother waveform that has lower amplitude and less detail
34
what does a dampened waveform do to systolic BP, diastolic BP, and MAP?
sys: underestimates dia: overestimates MAP: unchanged
35
5 causes of dampened waveform
``` 1- compliance in tubing 2- clotted off catheter 3- kinked catheter from flexed wrist 4- low pressure in the system 5- air bubbles (they are a source of compliance) ```
36
4 ways to fix dampened aline
1-aspirate/flush clot 2- extend wrist 3- make sure pressurized 4- aspirate air bubbles
37
Before treating a low BP what things should you check?
low BP isnt due to damened wave | transducer is at the correct level
38
underdampened waveform definition
RESONANCE too much waveform detail "hyperresonant" "overshoot"
39
what does a underdamped waveform do to systolic BP, diastolic BP, and MAP?
systolic: overestimatino diastolic: underestimation MAP: unchanged
40
6 causes of underdamped waveform (or resonance)
``` 1-defective transducer 2- tachycardia 3- long tubing 4- movement of catheter 5- catheter thats too large 6- increased vascular resistance ```
41
what test do you use to test the accuracy of the aline waveform
``` square wave (high pressure) test flush system ```
42
optimally damped waveform after square test
after flush returns to baseline after one oscillation
43
underdamped waveform after square test
wave oscillates multiple times before return to baseline
44
overdamped waveform after square test
wave returns to baseline without any oscillations
45
natural (resonant) frequency of aline
when pressurized system it oscillates at 20Hz natural frequency
46
fundamental frequency of aline
arterial waveform has frequency that is equal to the pulse rate
47
60 bpm = ____ Hz?
1Hz
48
120bpm= ____ Hz?
2hz
49
how much greater is the resonant frequency supposed to be than the fundamental frequency?
10x
50
if the natural frequency <10x fundamental frequency what happens?
waveform become distorted/inaccurate
51
constructive interference
two or more waves of similar frequency coincide to produce wave with higher peak amplitude
52
resonance waveform
similar to constructive interference but | bc of external FORCE with similar frequency applied
53
when can resonance occur with a lines?
bc pressurized tubing is external force if the natural frequency and fundamental frequency are similar then resonance possible
54
what could happen if the natural frequency decreases below 20Hz or increases fundamental frequency above 2Hz?
resonance more likely
55
where are the largest errors most likely to occur with resonance?
systolic pressure
56
how can the amount of damping be measured?
damping coefficient | damping ratio
57
what does damping counteract
resonance
58
high damping coefficient
dampened waveform
59
low damping coefficient
underdamping waveform
60
what is the optimally damped coefficient?
0.6-0.7
61
what is the most common aline cannulation site?
radial artery | superficial location and low complication rate
62
ulnar artery aline placement
- deeper and more difficult | - increased likelihood of nerve damage
63
if you have failed to place an aline in the radial artery should you try to place an ulnar aline on the same arm?
no | bc hematoma may disrupt bloodflow to hand
64
allens test (4)
1-pt makes fist 2- radial and ulnar arteries compressed 3- pt relaxes hand 4- pressure on ulnar released and observes how long it takes for blood to return
65
<7 sec allen test
positive (adequate circulation)
66
8-15 sec allen test
uncertain/ questionable
67
>15sec allen test
negative (inadequate circulation)
68
brachial artery aline
limited collateral circulation | only use when other sites are not available
69
axillary artery aline
has significant collateral flow high risk of nerve damange highest risk of cerebral emboli
70
is the right or left axillary artery more likely to cause cerebral emboli?
right axillary artery
71
what is the largest arterial line cannulation site?
femoral artery
72
when is a femoral artery contraindicated?
femoral central line on same side
73
what are the 3 complications unique to femoral aline placement?
1-hole in back of femoral artery lead to retroperitoneal bleed 2-femoral nerve damage 3- potentially higher infxn rate
74
femoral aline placement pneumonic
``` NAVEL lateral>medial nerve artery vein empty lymphatic ```
75
what is the most distal a line site?
dorsalis pedis and posterior tibial
76
what two things happen as the cannulation site becomes more distal?
``` loses detail (more dampened) higher systolic, lower diastolic and lower BP ```
77
why does the systolic BP read higher the more distal you go?
pulse wave from previous pulse reflected from arterioles and added (similar to resonance)
78
what are the 5 aline complications?
``` limb ischemia neurologic injury infection hemorrhage (disconnection) misinterpretation of data ```
79
what are the 4 causes of limb ischemia
thrombosis from multiple attempts small vessel compared to catheter accidental medication injection vasospasm
80
what are the 4 causes of neurologic injury?
needle hematoma near nerve prolonged wrist extension stroke because of thrombus or air emboli when flushing
81
why shouldnt we perform a continuous flush?
stroke because of thrombus or air emboli when flushing
82
misinterpretation of data acute hypertension
transducer falls to floor
83
misinterpretation of data acute hypotension
transducer raised above phlebostatic axis
84
hydrostatic pressure
effect of gravity on blood pressure
85
supine BP
only force effecting pressure is flow
86
standing pt BP
BP at base of foot is 133mmHg higher than artery at top of head (6ft tall)
87
phlebostatic axis
4th intercostal space mid axillary line represents external location of RA "zero point"
88
what height should the transducer be at?
phlebostatic axis
89
if the transducer is below the phlebostatic axis what will be the BP
falsely high BP
90
if the transducer is above the phlebostatic axis what will be the BP
falsely low BP
91
for every inch the transducer is below the tip of the catheter how much fluid pressure increases?
1.87mmHg
92
in sitting patients what will the height of the transducer estimate?
height on the body | you want it to be at the head
93
when placing the transducer at the brain where do you want it?
external auditory meatus
94
alternative to leveling at phlebostatic axis
taping to pt arm (not recommended esp. in sitting pts)
95
arm height effect on BP
as long as the transducer is leveled at the phlebostatic axis it has no influence on BP
96
do you have to zero the transducer at the level of the heart?
no

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