COMPS+CLINIC:FINAL: Unit 3: Lines and Tubes in Acute Care Flashcards
Ex’s of NON-invasive monitoring equipment
- EKG/Telemetry/Holter
- PulseOX
- BP machine
- EKG w/ RR
- Temp monitor
- Electroencephalogram (EEG)
Cardiac monitoring
Arterial Line
fun fact about this…..
Restricts joint mvmt***
Cardiac monitoring
Arterial Line
2 Functions:
- Continuously measures arteral BP—SBP/DBP (MAP)
- Allows access for drawing blood for ABG
cardiac monitoring
Arterial Line
LOCATION
Radial aa
Femoral aa
cardiac monitoring
Arterial Line
*talk about Positioning
POSITIONING for arterial line transducer is IMPORTANT***
*needs to be moved BEFORE pt if hanging
MUST STAY ABOVE RT. ATRIUM
Arterial Line
Ex. Radial Artery
see pics
PRECAUTIONS for Arterial Line
- Transducer for Arterial line shoud be pos’d @ lvl of Rt. Atrium—-> assures accurate pressure values
- Transducer LOW== HIGHER BP
- Transducer HIGH == LOWER BP
-
**if A-line dislodged—–apply pressure and notify nursing
- Maintain SLACK on line to prevent dislodge
- DO NOT let pt FLEX/EXT wrist to prevent aa damage
A-Line Transducer Pos’ing
If too LOW
HIGHER BP
A-line Transducer pos’ing
Transducer too HIGH
LOWER BP
Cardiac monitoring
Swan-Ganz cath/Pulm aa cath
EASIEST WAY TO RECOGNIZE IT
ITS YELLOW****
Swan Ganz cath/Pulm aa cath
Gets ALL PRESSURES of heart EXCEPT….
SBP
Swan Ganz cath/Pulm aa cath
Measures hemodynamic status in critically ill cardiac pts
What does this include??
- Pulm Cap Wedge Pressure (PCWP)
- pts w/ pulm edema OR pulm HTN
- Left atrial and Ventricular End-diastolic pressures
- Central venous pressure (CVP)
- CO
Cardiac Output
HR*SV===
amt. of blood pumped by the heart per unit of TIME
Swan Ganz Cath/Pulm aa cath
computes Cardiac Index
what is this?
Cardiac Index
- CO per sq meter of body surf area
-
SHOULD BE 3 OR >
- IF <2.1====Acute heart failure or cardiogenic shock
Swan Ganz cath/ pulm aa cath
allows IV access for what?
Medication admin AND obtain mixed venous blood gases
Swan Ganz/Pulm aa cath
Dx if using this:
Pulm edema OR Pulm HTN
LV heart failure
RV failure
Swan Ganz Cath/Pulm AA cath
Route/Pic
see below
Swan Ganz Cath
Has a balloon…what should you remember about this balloon???
NEVER see pt when balloon is Inflated
*Stops blood flow
Swan Ganz Cath and various pressures it reports:
- Balloon inflated== PCWP
- Prox Port in R. Atrium==CVP
- PCW==LAP
- ALL GIVES CO
Possible Complications of the PA Cath (Swan Ganz)
*remember its YELLOW!!!
- Comps of insertion and dislodgement of the PA Cath (swan ganz):
- Malignant arrhythmias
- Pulm aa rupture
- Pulm valve tear
- Infection
- ****if mobility is essential——need EXP’d clinician only AFTER pt is det’d hemodynamically stable
Green Light
Yellow Light
Red Light
ALL DEFINED
see pics
KNOW THIS!!!
Cardiovascular Considerations
Pulm aa cath (swan ganz) OR other continuous cardiac output monitoring devices
In-bed vs. Out-of-bed
IN BED====GREEN
OUT-OF-BED===YELLOW (CAUTION
CARDIAC monitoring
Rectal Temp Monitor
- Typ used w/ pts who are:
- Comatose
- Intubated
- HypOthermic
- Septic w/ HypERthermia
**Goes UP IN rectum
Cardiac monitoring
Trans Venous Pacemaker
- TEMP PM for the heart post-sx
- @ risk for arrhythmias W/OUT an underlying arrhythmia
- DO NOT MAKE TAUT
- goes thru diaphragm
- SA component vs. AV component—-has BOTH
Transvenous PM
GREEN light vs. YELLOW vs. RED
Dependent rhythm vs. Stable rhythm
-
DEPENDENT RHYTHM—-PM does EVERYTHING, pot. to go into arrhythmia
- IN-BED==YELLOW
- OUT-OF-BED==RED
-
STABLE RHYTHM
- IN-BED==GREEN
- OUT-OF-BED==GREEN
CARDIAC MONITORING
Automatic Implantable Cardiac Defribrillator
AICD
- TEMP Defribillator —-> Life Vest
PERMANENT PM’S and
AICD (Automated Implantable Cardiac Defrib.)
Sx placed WHERE
UNDER Left Clavicle
*ALWAYS LEFT
INTRA-Aortic Balloon Pump
IABP
- Assists w/
- Circulation of blood
- Reduces O2 consumption
-
PT Imps for mobilizing pts on IABP
- Femoral
- Axilla
-
*CAN ALSO BE A PM
- CA perfusion
- Pacing
- SV
Intra Aortic Balloon Pump
IABP
Inflation/Deflation
INFLATES during Diastole —-CA perfusion
DEFLATES during Diastole—–pumps blood OUT
Femoral IABP
IN-BED vs. OUT-OF-BED EX’S
- IN-BED====GREEN LIGHT
- OUT-OF-BED===RED LIGHT
Cardiac monitoring
Ventricular Assistive Device
VAD
Augments the pumping capability of the Heart
Ventricular Assistive Device
VAD
2 types:
-
LVAD
- L.Vent Assistive Device
-
BiVAD
- Bilateral Vent Assist Device
-
Dx:
- NON-reversible End-Stage HF