Critical Care Flashcards
What is the purpose of an arterial line?
Continual monitoring of arterial blood pressure and access to blood for arterial blood gas measurements. *Most commonly inserted in radial artery, but can also be inserted into femoral or carotid
What measurements does an arterial line provide?
Systolic, diastolic, and mean arterial pressure (MAP)
What are the PT implications for an arterial line?
AVOID removal of line due to increased risk of profuse bleeding.
Mobility may be LIMITED if line is inserted in groin (FEMORAL artery). Mobility should be normal for radial or carotid insertions.
What is MAP? What is the normal range ?
Reflection of tissue perfusion based on the average pressure pushing blood through circulatory system.
NORMAL: 70-110 mmHg
Inadequate Organ Perfusion < 60 mmHg
What is the purpose of a central line?
Allows IV access for MEDICATION administration directly into proximal SUPERIOR VENA CAVA. Also continuously monitors central venous pressure (CVP) and right arterial pressures (RAP) - Cardiac fxn.
*Inserted in SUBCLAVIAN or JUGULAR VEIN, sometimes femoral
What is used in patients requiring prolonged, placement of a central line?
PICC Line - Peripheral line inserted into cephalic or brachial vein and advanced towards the superior vena cava
Precautions for PICC line
Do NOT take blood pressure on ipsilateral arm
Do NOT get line wet
Caution with lifting
What is the purpose of a Pulmonary Artery Catheter? (Swan-Ganz)
Allows for direct measurements of RAP, PAP, PCWP, LAP, O2, CO, PVR and pacing of heart
*Inserted centrally into subclavian or jugular vein & advanced to PULMONARY ARTERY
What is important about the Swan-Ganz placement?
Very precise placement in the pulmonary artery. Caution with movement of line because it may block artery
Immediate risks associated with central venous access
Pneumothorax, bleeding, arrhythmias, & arterial entry
Delayed risks associated with central venous access
Infection, catheter fracture/dislodgement/occlusion, or air in the catheter
What is pulmonary capillary wedge pressure?
Associated with LAP & LVEDP - Both measure pressure within pulmonary circulation and peripheral resistance after diastole. Indicator of left ventricle performance
PAEDP = LVEDP
NORMAL: <12 mmHg
Why measure PCWP?
Assess severity of L ventricular function, mitral/aortic valve dysfunction, pulmonary edema, pulmonary HTN, and treat hypovolemic states
What is normal ICP - Intracranial Pressure
0-10 mmHg (adults)
0-5 mmHg (children <5 years old)
What is ICP highly correlated with?
Cerebral perfusion pressure. When ICP is high, perfusion pressure is low.
*Inverse relationship
Effect of CO2 on cerebral vessels
Hypercapnia (increased CO2) – Dilation
Hypocapnia (decreased CO2) – Constriction
Purpose of intraaortic balloon pump?
Assists in circulation throughout body and improving myocardial oxygen consumption in hemodynamically unstable patients
How does an intraaortic balloon pump work?
Balloon is inflated during diastole when aortic valve closes, creating an increased pressure that pushes blood into the aortic arch and stimulates a retrograde flow into coronary arteries to improve perfusion of myocardium
Precautions with intraaortic balloon pump
NO hip flexion on ipsilateral leg
BED REST until catheter is removed!
What is ECMO?
Life support machine that replaces the function of the heart & lungs for a few hours/days while they are waiting for a transplant.
Blood is pumped from the body to an artificial lung for oxygenation and CO2 removal, then it returns to the body.
What is a Berlin Heart?
Artificial heart pump that maintains blood flow in babies with serious heart failure. Pumps blood to aorta from left ventricle.
Only device that is like ECMO for babies - Very similar to LVAD for adults as well.
What condition do 80% of mechanically ventilated patients present with that can lead to negative outcomes like increased ICU stay, decreased survival and increased cognitive dysfunction?
Delirium
What are the three subtypes of delirium?
Hyperactive (ICU psychosis), Hypoactive (quiet delirium), or Mixed
What is called when patients present with remaining health problems after critical illness?
PICS - Post-Intensive Care Syndrome
