Arterial Lines COPY Flashcards
arterial line definition
like an IV but catheter inside artery
why are arterial lines more dangerous
if tubing is disconnected the patient could rapidly bleed to death
2 purposes for arterial lines
provide real time blood pressure
provide constant acess to blood samples for labs
catheter size used for adults arterial line
radial/brachial & femoral
20ga radial/brachial
18ga femoral
catheter size for pediatrics
20-22ga
catheter size for neonates
22-24ga
NIBP vs arterial line
NIBP tend to underread systolic and overread diastolic in comparison
what is the gold standard for BP?
arterial line
5 parts of a transducer system?
500mL bag of N/S arterial line tubing with pressure transducer pressure transducer cable pressure bag for the N/S transducer holder
what does the transducer do?
tells us how many mmHg are generated with each pulse
why use N/S vs why use heparinized saline?
N/S: less possibility of heparin induced thrombocytopenia
heparinized: less chance for aline to clot off
purpose of the pressure bag
prevent blood backup into the tubing bc arterial blood pressures are high
allows us to flush fluid into artery
how to flush arterial line
compressing the two doodads (or tail) on the transducer and opening roller clamp
Why should drugs/air bubbles never be given via the arterial route?
they can cause intense vasoconstriction and ischemia
what are the 4 reasons that an arterial line will not flush?
stopcocks turned off to the line
pressure bag underpressurized
roller clamp could be closed
aline clotted off
what should be done if an aline clots off?
try to aspirate the clot
then try to flush
4 steps of setting up an aline
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
Why do you inflate the pressure bag to 300mmHg?
no backflow of blood
3-6mL/hr drip into artery to prevent clot
when we zero an aline what are we eliminating?
the effect of atmospheric pressure
4 steps to zeroing an aline
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
why does caution need to be taken with where the stopcock is turned?
if it is off to the transducer then the patient could bleed to death
why do you put the cap on the stopcock after you turn the stopcock?
putting it on before could introduce pressure into the system
What are the materials needed for cannulating the artery?
chloraprep 4x4 tegaderm tape wrist support lidocaine (if awake) angiocath (biopatch??)
2 catheter options for cannulating artery
20ga arrow catheter
regular 20ga catheter
2 options for wrist extenders
rolled up towel
plastic support
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
upstroke of a line
systole
correlates with cardiac contractility
downstroke of a line
diastole
correlates with SVR
how is MAP calculated aline
integrating the area under the pressure curve
sloped upstroke vs sharp upstroke
SLOPED: poorer contractility
SHARP: good contractility
slow fall downstroke vs sharp fall downstroke
SLOW: vasoconstriction (high SVR)
SHARP: vasodilation (low SVR)
dichrotic notch
blood slams into the aortic valve and then is projected forward
dampened waveform definition
smoother waveform that has lower amplitude and less detail
what does a dampened waveform do to systolic BP, diastolic BP, and MAP?
sys: underestimates
dia: overestimates
MAP: unchanged
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)
4 ways to fix dampened aline
1-aspirate/flush clot
2- extend wrist
3- make sure pressurized
4- aspirate air bubbles
Before treating a low BP what things should you check?
low BP isnt due to damened wave
transducer is at the correct level
underdampened waveform definition
RESONANCE
too much waveform detail
“hyperresonant”
“overshoot”