Ch. 11 Pilbeams Flashcards by Joy Obilor-Okereafor

The primary indication of hemodynamic monitoring is:

Critically ill patients who demonstrate evidence of compromised cardiovascular function.

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Measurements typically include:

• systemic arterial pressure (SAP)
• central venous pressure (CVP)
• pulmonary artery pressures (PAP)
• arterial and mixed venous blood gases
• cardiac output

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Once obtained these measurements can be used to calculate:

• oxygen (O2)
• oxygen delivery (DO2)
• cardiac index (CI)
• vascular resistance
• cardiac work

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Measurements can also be used to:

Better define abnormalities in cardiopulmonary function and ultimately guide therapeutic interventions

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The outputs of the right and left ventricle are ultimately influenced by four main factors:

• heart rate
• preload
• contractility
• afterload

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Heart range can range from ____to ____ in a normal healthy adult

50 to 200

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What is preload?

The filling pressure of the ventricle at the end of ventricular diastole

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What is contractility?

The force that the ventricle generates during each cardiac cycle

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How can contractility be estimated?

The ejection fraction

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How is the ejection fraction calculated?

As the ratio of SV to the ventricular end diastolic volume

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What is afterload?

The impedance that the left and right ventricles must overcome to eject blood into the great vessels

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Impedance is described as?

Systemic and pulmonary vascular resistances

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What is SVR?

the afterload that the left ventricle must overcome to eject blood into the systemic circulation.

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What is PVR?

the afterload that the right ventricle must overcome to eject blood into the pulmonary circulation.

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Direct measurement of the systemic arterial pressure requires the insertion of a catheter into:

A peripheral artery such as:
• radial artery
• brachial artery
• femoral artery

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What are central venous lines:

Catheters places in the vena cava or right atria

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CVP catheters are usually inserted percutaneously into:

• a large central vein (internal jugular)
• peripherally through the medial basilic
• lateral cephalic vein

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What is the normal CVP?

2 to 6 mmHg

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What is this image? Fig.11.4

Balloon-tipped, flow directed right-sided heart catheter

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Label this image: Fig 11.4

Ballon inflation valve
Thermistor connector
Thermistor
Proximal lumen
Proximal injection port
Distal lumen
Ballon
Extra injection port
Distal injection port

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What does PAOP stand for?

Pulmonary artery occlusion pressure

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What does PCWP stand for?

Pulmonary capillary wedge pressure

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Are PAOP and PCWP the same?

Yes

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What is PAOP?

When you inflate the ballon to get a reading

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Should you leave the ballon inflated after getting a reading for PAOP?

**NO!!!!** Could cause an myocardial infarction (MI)

To measure pressure accurately transducer must be:

At the same height or level as the catheter tip

PAOP, which reflects preload of the left side of the heart, is a valuable parameter to monitor when performing an…?

Optimum PEEP study

If PAOP increases significantly during the study, it could indicate:

Overinflation of alveoli

The most common problem associated with CVP catheters is:

Pneumothorax

Balloon tipped flow directed catheters are also known as?

Swan Ganz Catheter or pulmonary artery catheter

The standard adult catheter is how long and comes in what sizes?

110 cm ; sizes 7&8 French

Catheters are marked in _____ cm increments?

_________ have one lumen that connects to a balloon located near the tip of the catheter and a second lumen that runs the length of the catheter and terminates at a port at the distal end of the catheter.

Dual lumen catheters

________have an additional proximal port that terminates approximately 30 cm from the tip of the catheter, or at the level of the right atrium.

Triple lumen catheters ***This third lumen can be used to measure right atrial pressures or for administrating intravenous medications.***

________incorporate a thermistor connector, which contains electrical wires that connect to a thermistor located approximately_______from the tip of the catheter

Thermodilution ; 1.5 inches (3cm)

When measuring cardiac output using the thermodilution technique,__________(cold or room temperature) is injected through the catheter's third (proximal) lumen, which is positioned ________.

a bolus of saline or 5% dextrose ; at the level of the right atrium.

What is a normal heart rate?

60-100 bpm

Bradycardia is what?

Heart rate < 60 bpm

What is tachycardia?

HR > 100bpm

What is the normal range for systolic pressure in adults?

90 to 140 mmHg

What is the normal range for diastolic pressure for an adult?

60-90 mmHg

What is the normal mean arterial pressure (MAP)?

70-100 mmHg

What is systemic hypertension?

Systolic arterial pressure greater than 140 mmHg and diastolic pressure greater than 90 mmHg

What is systemic **hypo**tension?

Systolic pressure is less than 100 mmHg and diastolic pressure is less than 60 mmHg

What is pulse pressure?

Systolic pressure - diastolic pressure

A wide pulse pressure is associated with what?

An increased stroke volume and a decreased arterial compliance

What is a narrow pulse pressure associated with?

Decreased stroke volume and increase arterial compliance

What is the range for PAOP?

5 to 12 mmHg

PAOP greater than 25 mmHg means what?

Cardiogenic pulmonary edema from left sided heart failure

What is the normal PA systolic pressure for a healthy adult?

15 to 35 mmHg

What is the normal PA diastolic pressure for an adult?

5 to 15 mmHg

PAOP plays a major role in the assessment of?

Pulmonary hydrostatic pressure in the formation of pulmonary edema

PAOP can help distinguish the difference between?

Cardiogenic pulmonary edema and non-cardiogenic pulmonary edema

PEEP greater than 15 cmH2O can produce what?

Erroneously elevated pressure readings

What is cardiac output?

Volume of blood that is pumped by the heart per minute **Usually expressed in liters per minute or milliliters per minute**

What is the normal range for cardiac output?

4-8L/min

How can cardiac output be calculated?

SV x HR

What is the formula for cardiac index?

CI=Q/BSA

What is the formula for stroke index?

SI=SV/BSA

What is normal cardiac index for an adult?

2.5 to 4 L/min/m2

What is the normal range for a stroke index?

35-55mL/beat/m2

What is the Fick principle?

Q=VO2/(CaO2-CvO2) x 10

Cardiac output involves direct measurements of what?

• O2 consumption • arterial and mixed venous O2 contents

What is the normal SvO2?

75%

What is the normal CvO2?

15vol% (150mL/L of whole blood)

Mixed venous oxygen value declines when arterial oxygenation is________?

Decreased

With a reduced cardiac output more time is available for the extraction of_____ from blood delivered to the tissues?

Mixed venous oxygen values can be higher than normal in patients with________?

Histotoxic hypoxia & in situations with pulmonary shunting

DO2 is the product of _____?

Cardiac output and arterial oxygen content

DO2 represents?

The total amount of oxygen that is carried in the blood to the tissues each minute

DO2 is approximately?

1000mL or about 550 to 650 mL/min/m2

DO2 is increased in situations in which_____?

Cardiac output or arterial oxygen content is elevated

A reduced DO2 indicate a decrease in what?

Cardiac output or arterial O2 content

DO2 is increased in?

Hyperdynamic states (increase cardiac output) such as septic shock

What is a shunt?

A portion of cardiac output that does not participate in gas exchange with alveolar air **(perfusion without ventilation)**

Shunts are usually identified as:

• anatomical shunts • intrapulmonary shunts • physiological shunts **latter being the sum of anatomical and intrapulmonary shunts**

What is the normal range for a shunt?

2 to 3% of normal cardiac output

What is the equation for physiological shunt?

Qs/Qt= (CcO2 - CaO2)/CcO2-CvO2

Why do we multiply SVR and PVR by 80?

To convert the units from mmHg/L/min to dyne x second x cm^-5

SVR will increase as ______ increases?

Blood viscosity ***(occurs in polycythemia)***

SVR decreases during?

Systemic vasodilation **occurs with moderate hypoxemia or after administration of systemic vasodilators such as nitroglycerin or hydralazine**

PVR increases during what?

• Periods of alveolar hypoxia • When high intraalveolar pressures are generated **such as during positive pressure ventilation**

What is the normal EF value?

50-70%

During ventricular systole or atrial diastole when the tricuspid valve is CLOSED the pressure measured in the right atrium or vena cava reflects_____

Right atrial pressure (RAP)

At the end of ventricular diastole and atrial systole when the tricuspid valve is OPEN the pressure measured in the right atrium reflects ________

Right ventricular pressure (RVP).

What is the standard size and length for pediatric catheters?

60 cm in length; size 4 and 5 French

What is the rate that flush runs through the catheter?

1-5 mL/h

It is important to fully inflate balloon to avoid?

• endocardial pulmonary artery damage • induced ventricular arrhythmias

What is the balloon volume for a pediatric catheter?

0.8 mL

What is the balloon volume for an adult catheter?

1.5 mL

The balloon should only be inflated for how long when measuring PAOP?

15 to 30 seconds **particularly in patients with pulmonary hypertension**

What is the indicator for left ventricular preload?

Left ventricular and diastolic pressure (LVEDP)

What is the indicator for contractility?

Ejection fraction

What is the indicator for afterload?

SVR and PVR