Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Principles I > CV and PA catheters > Flashcards

CV and PA catheters Flashcards

1
Q

what are some indications for CVL placement?

A
  • CVP monitoring
  • Pulmonary artery catherization
  • hemodialysis
  • temporary transvenous pacing
  • aspiration of air emboli (*all sitting craniotomies)
  • infusion of vasoactive drugs or TPN
  • need for repeated blood sampling
  • IV access (inadequate PIV access) *fluid resuscitation
  • cannulae placement (veno-venous bypass; portosystemic shunt)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is CVP monitoring?

A
  • measure right atrial pressure (RAP)
  • RAP in an indirect determinant of RV function
  • CVP= RVEDP
  • main indicator of venous return (preload)
  • used as an indicator of fluid volume
  • in healthy people, RV fxn reflects LV fxn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

where is CVP measured and what is normal value?

A
  • measured at the junction of SVC and RA
  • normal value: 1-8 mmHG
  • PPV and PEEP can cause falsely high readings
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

describe the CVP waveform

A
  • 3 waves and 2 descents
  • a wave
  • c wave
  • x descent
  • v wave
  • y descent
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what does the a wave represent in the CVP waveform?

A

atrial contraction producing an initial spike then descent as blood leaves atrium and fills the ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what does the c wave represent in the CVP waveform?

A

closed tricuspid elevates during isovolumic ventricular contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what does the x descent represent in the CVP waveform?

A

downward movement of tricuspid valve during systole and atrial relaxation when the base of the heart descends

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what does the v wave represent in the CVP waveform?

A

venous return against a closed tricuspid valve during systole (atrial filling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what does the y descent represent in the CVP waveform?

A

opening of tricuspid valve during diastole as atrial pressure is higher than ventricular pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what changes in the CVP waveform are seen with atrial fib?

A
  • no a wave (no atrial contraction)

- prominent C-V waves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what changes in the CVP waveform are seen with AV asynchrony?

A
  • large a wave d/t atrium contracting against closed tricuspid during ventricular systole
  • AV dissociation, V pacing, AV nodal rhythms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what pathologies cause a large a wave in the CVP waveform?

A
  • pulmonary HTN

- decreased RV compliance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what changes in the CVP waveform are seen with tricuspid regurgitation?

A

-broad, tall systolic C-V wave or “regurgitant V wave”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what changes in the CVP waveform are seen with tricuspid stenosis?

A

tall end diastolic A wave with an early diastolic Y descent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what can cause giant a waves in the CVP waveform?

A
  • junctional rhythms
  • complete AV block
  • PVCs
  • v pacing
  • tricuspid or mitral stenosis
  • diastolic dysfunction
  • myocardial ischemia
  • ventricular hypertrophy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what can cause large v waves in the CVP waveform?

A
  • tricuspid or mitral regurgitation

- acute increase in intravascular volume

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what causes a high CVP?

A
  • LV failure
  • RV failure
  • pulmonary HTN
  • cardiac tamponade
  • pulmonary embolism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what causes a decrease in CVP?

A

hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is PA pressure monitoring?

A
  • multitude of direct and indirect measurements assessing volume and pressure which yield a picture cardiovascular and pulmonary function
  • most important measures are CO and PAOP (wedge pressure)
  • allows approximation of pressures and volumes from the left side of the heart
  • allows mixed venous blood sampling
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are contraindications of PAC insertion?

A
  • coagulopathy
  • thrombolytic treatment
  • prosthetic heart valve
  • endocardial pacemaker
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what are some complications of PAC placement?

A
  • dysrhythmias (mainly insertion- 70% PVCs- and removal)
  • RBBB-damage to conduction bundle of HIS
  • catheter knotting
  • thromboembolism (less w/ heparin coated catheters)
  • pulmonary infarction (prolonged balloon inflation; distal cath migration)
  • infection (greater than 5-7 days)
  • valvular damage and endocarditis
  • pulmonary vascular injury (rare)
  • *blood in ETT addressed immediately (balloon inflation may cause pulmonary hemorrhage)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

describe PAC insertion technique

A
  • advance catheter while monitoring pressure waveform
  • inflate balloon when the catheter tip enters the central circulation (around 20 cm) inflate with 1.5 ml
  • never advance when balloon is deflated
  • if R to L inracardiac shunts, use CO2 NOT air to prevent embolus
  • advance until the waveform appears to dampen and value is lower than PADP (wedge or PAOP)
  • when balloon is deflated, waveform returns to PA pressures
  • deflate before removing
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is PAOP measurement?

A
  • PCWP- measures the back pressure (LV preload) from the pulmonary venous system
  • gives more accurate estimation of LAP and thus LV preload than CVP
  • estimates LVEDP
  • normal 8-12
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

where does tip need to be for PAOP measurement?

A

in supine position, tip should be in lung zone 3 where a continuous full column of blood resides

25
Q

what may cause the balloon to reside in lung zone 1 and 2?

A
  • PPV
  • hypovolemia
  • various positioning
26
Q

why is zone 3 optimal?

A
  • zone 1: alveoli pressure is greater than vessels, collapsing pulmonary capillaries and no blood flow
  • zone 2: pulmonary capillaries are open in systole and compressed during diastole (alveoli pressure > pulm. veins)
  • zone 3: both pulmonary artery and vein pressure are greater than alveoli; continuous blood flow
27
Q

what conditions can make PAOP read higher than LVEDP?

A
  • tachycardia > 130 bpm
  • PEEP (increased pulmonary venous congestion or PVC)
  • catheter tip in zone 1 or 2 (increased PVC)
  • COPD (increased PVC)
  • pulmonary venoocclusive disease
  • mitral valve regurgitation
  • mitral stenosis
28
Q

what indicates an increased in pulmonary artery vascular resistance (PVR)?

A
  • PA diastolic pressure 4 mmHG or higher than PAOP
  • normally only 1-4 mmHG > PAOP
  • greater increase in PVR, greater difference b/w PA diastolic and PAOP
  • increase PVR causes PA systolic and diastolic to increase but not PAOP
29
Q

what can cause an increase in PVR?

A
  • hypoxemia
  • pulmonary embolism
  • acidosis
  • pulmonary vascular disease
30
Q

what conditions cause an increase in PAOP?

A
  • restrictive cardiomyopathy
  • cardiac tamponade
  • LV failure
  • all looking ahead
31
Q

what condition do not affect PAOP?

A
  • pulmonary embolism
  • pulmonary HTN
  • RV failure
  • all behind balloon
32
Q

what condition cause a low PAOP?

A

hypovolemia

33
Q

what is overwedging?

A
  • balloon hyperinflation or prolonged inflation
  • can result in false elevation of PAOP values
  • build up of intracatheter pressure from the high pressure flush system
  • no a waves and v waves
  • slow, progressive rise in wave then falls and rises again
  • values unusable
34
Q

what is most preferred CVL insertion site?

A

RIJ

35
Q

what is the most preferred CVL site for long term use?

A

SC vein

36
Q

what length catheter should be used with each insertion site?

A 
SC: 10 cm
RIJ: 15 cm
LIJ: 20 cm
Femoral: 40 cm
Rt median basilic: 40 cm
Lt median basilic: 50 cm
37
Q

what are some complications of CVL insertion?

A
  • vascular structure injury (carotid most common)
  • pleura injury (pneumothorax)
  • nerve bundle injury
  • lymphatic system injury
  • rare spinal canal injury
38
Q

what are the advantages of the RIJ?

A
  • easily identifiable landmark
  • straight course to SVC
  • easily accessible at patient’s head
  • high success rate (91-99%)
  • bleeding easily recognized and controlled
  • reduced risks of pneumothorax
39
Q

what are the disadvantages of the RIJ?

A
  • increased risk of infection (oral secretions)
  • increased risk of unintentional carotid artery puncture
  • unable to access if patient is in cervical collar
40
Q

describe RIJ insertion technique

A
  • landmark: triangle from two heads of SCM muscle (IJ found in the groove b/w two heads)
  • aseptic: mask, gown, gloves,cap
  • supine, mild trendelenburg, head turned slightly left (> 40 degree IJ to overlap with IC)
  • palpate IC with L hand, IJ lateral and anterior to IC
  • SQ lidocaine
  • insert 22-23 gauge seeker needle at apex of triangle at 30 degree angle toward ipsilateral nipple (go lateral!)
  • keep fingers on pulsating carotid, aspirating while advancing needle until dark blood enters syringe
  • aspirate, advance 18 g. parallel with seeker needle until dark blood enters syringe
  • withdraw seeker, remove syringe from 18 g. needle holding thumb over hub to prevent air
  • insert guide wire then remove 18 g needle
  • watch for ventricular ectopy
  • use knife to cut and enlarge entry site
  • insert and remove vessel dilator 2-3x over wire
  • insert CVL over wire advancing tip to junction of SVC/RA
  • aspirate and flush all lumens
  • secure with suture and place sterile occlusive dsg.
  • CXR to confirm placement
41
Q

what are the advantages of the left IJ?

A
  • easily identifiable landmark
  • easily accessible at the patient’s head
  • bleeding easily recognized and controlled
42
Q

what are the disadvantages of the left IJ?

A
  • greater risk for pneumothorax b/c pleura is higher
  • thoracic duct enters the venous system at the junction of the LIJ and SC veins
  • smaller vessel with a more overlap of the carotid artery
  • catheter must traverse the innominate and enter the SVC more perpendicular leading to more vascular injuries
43
Q

what are the advantages of the SC vein?

A
  • infection risks are reduced
  • cervical instability (C-collar) trauma patients
  • patient comfort
  • larger vessel doesn’t risk collapse
44
Q

what are the disadvantages of the SC vein?

A
  • increased risk of pneumothorax
  • more difficult landmarks in obese
  • less assessable (under drape)
  • more difficult to identify bleeding (under drape)
45
Q

describe infraclavicular SCV insertion technique

A
  • place in trendelenburg with arms at sides, head turned away, and roll placed between shoulder blades
  • identify landmarks of clavicle, suprasternal notch
  • aseptic prep, skin puncture is made 2-3 cm caudad to mid clavicular point
  • seeker needle tip inserted while aspirating and directed towards the suprasternal notch
  • advance needle more cephalad b/c vessel lies directly under surface of clavicle
  • once vessel identified, utilize same technique as IJ
  • CXR confirmation
  • watch for difficulty breathing or s/sx of pneumothorax
46
Q

what are the advantages of the EJ?

A
  • closer to surface
  • more easily identified
  • preferred with patient with coagulopathy
  • less risk of IC puncture
47
Q

what are the disadvantages of the EJ?

A
  • smaller vessel, more difficult to advance catheter

- can be more easily kinked

48
Q

with the U/S guidance, short axis provides?

A

a transverse plane of the vessel

49
Q

with the U/S guidance, long axis provides?

A

a longitudinal plane of the vessel

50
Q

what type of transducer is used?

A

linear

51
Q

describe linear probes

A
  • frequency 7-15 MHz
  • high frequency transducer
  • good for superficial structures
  • gives crisp, sharp images
52
Q

describe curved probes

A
  • frequency 2-5 MHz
  • low frequency transducer
  • good for deeper structure
  • image depth 4-8 cm
53
Q

what is reflection?

A

waves bounce away and return to probe for processing

  • needles reflect U/S very well (echogenic even better)
  • shown as bright white display on monitor
  • high frequency probes reflect best
54
Q

what is refraction?

A

waves bounce away from probe

55
Q

what type of needle angle is best?

A
  • small needle angles (less than 30 degrees)
  • regardless of short or long axis
  • more perpendicular b/w needle and sound beam
  • starting needle farther away will increase wave return
  • enhanced sound wave return (fewer waves experience refraction; almost all waves are reflected)
56
Q

describe U/S technique

A
  • linear array handheld transducer placed over landmark
  • identify relationship b/w IJ and IC in transverse (short axis) view
  • using 2-D or color flow differentiate IJ and IC
  • guide needle into vessel using short axis view
  • use long axis to visualize advancement of wire in vessel
57
Q

using 2-D, how can the IJ and IC be differentiated?

A
  • compressibility: IJ decrease in size when transducer pressure applied
  • expandable: IJ will increase in size when Valsalva maneuver or trendelenburg position
58
Q

using color flow Doppler (CFD) how can IJ and IC be differentiated?

A
  • in short axis view
  • flow: blue = away; red = toward
  • transducer oriented caudad (toward tail) for IJ
59
Q

what is the proper placement of the probe marker and why?

A
  • marker must be facing left
  • ensures IJ is always lateral and IC is always medial (unless crossed)
  • in long axis, marker should be towards the head

Principles I (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions