Complex: Lines & Hemodynamics Flashcards
Lines: Describe a normal assessment of an arterial line
The extremity distal to the arterial line should be warm to the touch and have sensation that is baseline for the patient. The site should be visible without excessive drainage and the surrounding tissue should be soft. Any altered findings should be reported immediately
Lines: Describe the process of using a central line for medication delivery or blood draw.
When using a central line, you must use aseptic technique, check that the dressing is pristine and the site is free of signs of infection. Before using the line, scrub the hub for at least 15 seconds, use a 10cc syringe, and change the cap if blood is drawn.
Lines: State the concept of the transducer used in arterial line pressure measurement.
The transducer is the part of the arterial line that ensures proper pressure readings through its connection to the closed pressure system. In order for accurate pressures to be seen, the transducer must remain at the phlebostatic axis located at midaxillary, 4th intercostal space of the patient.
Hemodynamics: Describe pulse pressure and mean arterial pressure
Pulse pressure is the difference between the highest pressure during systole and the lowest pressure during diastole.
Normal range is 40-60.
SBP (-) DBP
Mean arterial pressure is the mean pressure in the arteries during one full cardiac cycle. The MAP is an indication of tissue perfusion.
Normal range is 70-100
1/3 of DBPx2 (+) SBP
Hemodynamics: Describe the first nursing action when there is a sudden change in vital signs
A sudden change in vital signs warrants the nurse to compare patient presentation with the data.
CVC: Describe nursing measures to prevent CLABSI (central line associated blood stream infection)
Scrub the hub for at least 15 seconds and allow to dry for 15 seconds before administering medications or drawing blood
Assess site for any sign of warmth, redness, or drainage
Practice excellent hand hygiene
Check the dressing and keep it pristine
Art. Line: Describe the purpose of the transducer used with a radial arterial line
When a patient has an arterial line, the transducer should be placed at the phlebostatic axis, which is approximated at the 4th intercostal space and midaxillary line. The purpose of the transducer is to provide an interface between the a.line catheter and the monitor using pressure. A misplaced transducer will not give accurate data for intravascular and intracardiac pressure.
CVC: Explain a pneumothorax as a complication of a subclavian central line insertion
The location of a subclavian central line present a high risk for lung puncture during the insertion process. In this instance, the patient would demonstrate diminished breath sounds on the affected side
CVC: Describe the rationale for sending a central line catheter tip to the lab for testing
When a patient with a central line manifests signs of infection, the central line should be considered suspect for infection. First, the healthcare provider must be notified and then if instructed, the line should be removed and the tip should be sent to the lab to identify the source of infection
CVC: Explain the rationale for using a 10ml syringe when drawing blood from or administering medications through a central line
Anything smaller than 10ml syringe may compromise the central line by altering the pressure within the line
CVC: Describe the methods of confirming proper placement of a central line
- Use U/S guidance
- CXR confirmation before use
- Observe color of blood from line
CVC: Describe the rationale for drawing blood with a peripheral stick rather than from a central line in the presence of potential infection
When infection is suspected and the source of infection is unknown, it is important to use blood from a peripheral lab draw so that the risk of a false positive central line infection is eliminated
Lines: Describe the rationale for measuring the circumference of a limb with a central line, including a PICC line.
Swelling of a limb with a line can indicate a complication including a clot or rupture on the catheter
Lines: Describe the term, “pristine”, when describing central line dressings.
All central line dressings should remain “pristine”, meaning that that there should be no evidence of dressing disturbance including drainage, rolled edges, or visible catheter. These disturbances may indicate a catheter dislodgement or potential infection risk.
Hemodynamics: Describe the things that have the biggest impact on stroke volume
Preload refers to the “stretch” of the left ventricle at the end of diastole (End-Diastolic Volume).
Afterload refers to the “squeeze” of the left ventricle at the end of systole (End-Systolic Volume).
Contractility refers to the effectiveness of the pump to produce contractions that push the blood into the body.
