CVP & Art Flashcards by Christine Deihl

What are the indications for CVP catheters?

Give Fluids, drugs, blood, TPN
Monitor fluid status
Blood Sampling

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T or F: CVP lines can read how much pressure and where the pressure is located

False: CVP lines only can read pressures, not where the pressures are located

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T or F: CVP lines cannot differentiate between rt & left heart or lung problems

True

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Right Arterial pressure reflects:
1.  Right Vent end diastolic pressure
2.  Left arterial pressure
3.  When tricuspid valve open
4.  When pulmonary sl valve open
A.  1, 2, 3
B.  1, 2
C.  1, 3
D.  1, 2, 4

C: Rt arterial pressure reflects rt ventricular end diastolic pressure when tricuspid valve open

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Name 5 locations where CVP lines can be inserted

Right internal Jugular Vein
Subclavian
Brachial
Medial Basilic
Lateral Cephalic

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What waves are created and what do they correspond to on ECG?

A-wave = P-R
C-wave = QRS
V-wave = T wave

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Central Venous pressure catheters can provide an indication for 
A.  Left ventricle afterload
B.  Right heart preload
C.  Left heart preload
D.  Right ventricle afterload

B. Right heart preload

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What are complications of CVP: 7

Infection
Thromboembolism
Thromboplebitis
Vasal damage at insertion
Bleeding
Hemo/pneumothorax
Air embolism

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What 4 pieces of equipment are needed:

3 way stopcock
IV solution
3 port cvp catheter
Transducer of water manometer

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What is a normal CVP pressure?

2-6 mmHg

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Name 5 causes when a CVP may be less than 2 mmHg

Hypovolemia
Vasodilation by drugs or increase in temp
Spontaneous inspiration
Transducer below right atrium
Air bubbles or leaks

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Causes of high CVP include (10 total)

Volume overload
Infusion of blood/fluids
Cardiac tamponade
Rt heart failure
Left heart failure
Tricuspid stenosis/regurg
Pulm valve stenosis
Pulmonary embolism
Pulm hypertension
increased intra-thoracic pressure

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What does CVP monitor?

right heart pressure

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During systole a CVP is reading actual/inferred right atrial pressure, then it reads actual/inferred right ventricular pressure

Actual
Inferred
CVP reads right atrial pressure & reflects right ventricular pressure

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What is the formula for SV?

SV = EDV - ESV

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What is the formula for EF (ejection factor)

EF = SV/EDV x 100%

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What is a main limitation of CVP?

Can’t tell you where problem in heart is

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What is another name for CVP?

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T or F: If an increased pressure is measured it can be inferred that an increased volume is present

False: catheters are measuring pressures but this does not mean more volume

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Name 4 indications for Arterial catheters

Arterial pressure in unstable patients: receiving vasoactive drugs, extremes in BP, or increased sV
Obtaining ABG
Determining CMO
May include gas analyzers

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What are sites of insertion for Art Catheters?

Radial
Axillary
Brachial
Dorsalis pedis
Femoral (if BP low or clotting in radial)

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What is most common site of insertion of Art Catheters?

Radial

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What are 6 complications of arterial catheters

Arteritis
Bleeding
Clot Emboli
Infection
Air emboli
Ischemia & necrosis

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What equipment is needed for arterial catheters?

Arterial Line Kit
Heparinized IV solution
Leur Lock
Transducer
Recorder/monitor

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What is the formula for MAP?

map = systolic + (diastolic x 2)/3

How can you find pulse pressure?

Systolic press - diastolic pressure

What causes the dicrotic notch to form on arterial pressure waveform?

produced by aortic valve closing

What happens to your waveform when diastole progresses?

Pressure falls to lowest level

What is the normal diastolic pressure?

60-90 mmhg

What is your normal systolic pressure?

120 mmHg

What causes decrease in pressure in art catheter?

hypovolemia: fluid blood loss, cardiac failure, cardiac failure, vasodilation aortic stenosis arrhythmias

What causes increase in art pressure?

``` Increased volumes vasoconstriction drugs that cause vasoconstriction arteriosclerosis aortic insufficiency ```

``` Pulse pressure is a measurement of A. Blood pressure B. Gross estimate of CMO C. SV D. Compliance E. Arterial Resistance ```

B, C, D, E

``` What might cause an increase in systolic pressure? 1. Increase in SV 2. Decreased in compliance 3. Increase in compliance 4. Decrease in SV A. 1, 2, 4 B. 1, 2 C. 3, 4 D. 1 only ```

B. increase in SV, decrease in compliance can cause increase in systolic pressure

What is a normal MAP range

80mmHg | 70-110 mmHG

What does MAP indicate if normal?

Good indicator of tissue perfusion

If your MAP is less than ______ it means vital organs not being perfused

What causes a reading in cuff pressure?

Vibrations of arterial wall

When you have an increased arterial contraction it causes an increase/decrease in diastolic runoff;

decrease in diastolic runoff and decrease in pressure gradient

Cuff pressure is A. higher than arterial pressure by 5-20 mmHg B. lower than arterial pressure by 5-20 mmHg C. Falsely low by 25 mmHG D. Falsely high by approx. 25 mmHg

B. Cuff pressure is 5-20 mmhg lower than arterial pressure

Which is higher: arterial pressure or cuff pressure?

Arterial pressure is higher

Hemodynamic monitoring is defined as? A. Physical characteristic of blood flow B. Physical characteristic of blood perfusion C. Both airway and blood flows D. Invasive monitoring of blood vessels

A. physical characteristic of blood flow

``` The majority of blood flow at 2/3 of total takes place where? A. Arteries B. Aorta C. Veins D. Pulmonary vasculature ```

C. 2/3 of blood volume is in venous system

Which system allows for assessment of right heart, lungs & left heart A. CVP B. PAC C. Arterial Catheter

B. PAC

T or F: An arterial catheter is directed into pulmonary artery by a balloon tip

False; Swanz Ganz or PAC goes into pulmonary artery

T or F: The SV of left heart should match SV of right heart

True; if not & varies by 0.1 ml will cause pulmonary edema

Indications for PAC include:

Right heart function Pulmonary function Left heart function

If I needed to determine the CMO of a patient which catheter would you use? A. CVP B. Art Catheter C. All of the above

Arterial Catheter will allow you to measure CMO

If I need to give TPN which type of catheter would you use A. CVP B. Art Catheter C. All of the above

A. CVP

This type of catheter often includes gas analyzers? A. CVP B. Art Catheter C. All of the above

B. Arterial Catheter

This type of catheter will allow you to obtain blood samples? A. CVP B. Art Catheter C. All of the above

C. All of the above

Complications can include Arteritis, clot emboli, air emboli, ischemia, or necrosis A. CVP B. Art Catheter C. All of the Above

B. Art Catheter

An indication for this includes to monitor fluid status? A. CVP B. Art Catheter C. All of the above

A. CVP

Locations for insertion include RIJ, subclavian, medial basilica, lateral cephalic A. CVP B. Art Catheter C. All of the above

A. CVP

This type of catheter can be inserted in the dorsalis pedis, axillary, radial, brachial, and femoral? A. CVP B. Art Catheter C. All of the above

B. Art Catheter

Complications can include hemo/pneumothorax, air embolism, thromboembolism, thrombophlebitis? A. CVP B. Art Catheter C. All of the above

A. CVP

This can measure pulse pressure? A. CVP B. Art Catheter C. All of the above

B. Art Catheters

This measures right heart pressure? A. CVP B. Art Catheter C. All of the above

A. CVP

Hypovolemia can cause a decrease in pressure in? A. CVP B. Art Catheter C. All of the above

C. All of the above

Arrhythmias, & aortic stenosis can cause a decrease in evaluation of pressure in? A. CVP B. Art Catheter C. All of the above

B. Arterial Catheter

Arteriosclerosis may cause an increase in pressure in A. CVP B. Art Catheter C. All of the above

B. Art catheters

Cardiac tamponade may cause high pressure in A. CVP B. Art Catheters C. All of the above

A. CVP

Pulmonary hypertension & pulmonary hypertension may cause an increase in A. CVP B. Art Catheters C. All of the above

A. CVP

Increased intra thoracic pressure would cause an increased pressure in A. CVP B. Art Catheters C. All of the above

A. CVP

Infusion of blood/fluids may cause an increase in pressure in A. CVP B. Art Catheters C. All of the above

A. CVP

``` A gross estimate of CO is a result of? A. Stroke volume B. Arterial Compliance C. Arterial Resistance D. All of the above ```

D. all of the above

What value is a good indicator of tissue perfusion?

MAP

Vasodilation will cause a low pressure reading in? A. CVP B. Art Catheters C. All of the above

A. CVP

``` When the tricuspid valve opens at end of diastole then pressure measured in right atrium is? A. Left atrial pressure B. Left Ventricular pressure C. Pulmonary artery pressure D. Right Ventricular pressure ```

D. RVP

``` Pressure measurements are often done during A. Inhale B. Exhale C. Both D. does not matter ```

B. exhale

In a CVP pressure readings of right atrium are direct reading, is right ventricle pressure actual? A. Yes B. No, it is not available C. No, it is reflective

C. right vent pressure is reflected

Why can a CVP cannot tell you what is happening ahead in the lungs?

because the valves are never all open at same time

T or F: CVP can often cause heart valve complications

False, CVP is not placed in the heart so would not cause valve complications

If you have spontaneous inspiration it can cause a low pressure reading in? A. CVP B. Arterial lines C. All of the above

A. CVP

What is a normal pressure reading for the right atrium?

2-6 mmHg

What is a normal reading for the right ventricle?

20-30 mmHg in systole | 0-5 in diastole

What is a normal reading for pulmonary artery?

20-30 mmHg | 6-15 mmHg in diastole

What is a normal pulmonary capillary wedge pressure?

4-12 mmHg

``` What is a normal diameter of the PAC? A. 110 cm B. 4-8 F C. 2-6 cm D. 60 cm ```

B. 4-8 french

``` What is normal length of PAC? A. 110 cm B. 4-8 F C. 2-6 cm D. 60 cm ```

A. 110

When looking at a PAC the following colors represent certain parts, name them Yellow = ? Red = ? Blue = ?

Yellow is Distal port Red is Port to balloon Blue is Proximal

What part measures venous saturation?

O2 Saturation

This measures blood temperature for CMO?

Thermistor

Where can a PAC be inserted? name 5

``` Internal jugular subclavian basilica cephalic femoral ```

``` The following catheters can be inserted into the internal jugular? A. CVP B. Art Catheter C. PAC D. All of the above E. A & B F. B & C G. A & C ```

G. A & C; both cvp & PAC can be inserted into IJ

T or F: A common site to insert the CVP is the femoral site?

False, RIJ, Subclavian, Brachial, Medial basilica, lateral cephalic are common locations of insertion for CVP

What is a site the PAC can be inserted that CVP cannot?

Femoral

What is a site of insertion for CVP but not PAC?

Brachial

``` When inserting a catheter, which can be inserted in the dorsalis pedis? A. CVP B. PAC C. Art line D. All of the above ```

C. arterial line

``` If someone develops a clot emboli they probably have which type of catheter A. CVP B. PAC C. Art line D. All of the above ```

C. Arterial lines

``` The anacrotic limb is seen on a waveform of? A. CVP B. PAC C. Art line D. All fo the above ```

C. Art line

What causes the highest pressure in the pulmonary artery during systolic pressure? A. Rt Ventricular SV B. Rate of blood ejection from rt ventricle C. Blood ejection in the left ventricle to systemic circulation D. Elasticity E. Resistance F. A, B, C G. A, B, D H. All of the above

G. A, B D highest pressure in ventricular caused by rt vent stroke volume, rate of blood ejection from rt ventricle, elasticity of pulm arterial tree

``` Where should a transducer be placed? A. Elevated above head B. Below the chest C. at midchest D. any would beok ```

C. midchest

For every inch the transducer is placed above midchest will cause vascular or intra cardiac pressure to be ______ less than actual.

2 mmHg less if transducer above chest

If transducer is set below patient chest its readings will be A. falsely high B. Falsely low C. accurate within acceptable range D. dependant upon resistance in vascular system

A. falsely high reading

``` By setting the transducer at midchest it prevents effects of _______ pressure. A. MAP B. actual C. plateau D. hydrostatic ```

D. hydrostatic pressure

``` If transducer is set too high what happens to your pressure reading? A. Falsely high B. Falsely low C. no change in pressure D. MAP decreases ```

B. Falsely low

``` This catheter only reads whether pressure high but unable to identify the source A. CVP B. Art C. PAC D. All of the above ```

A. CVP

``` If I need to measure the left heart pressures which should I use? A. CVP B. ART C. PAC D. Any of the above ```

C. PAC

``` A pneumothorax is complication of which procedure A. CVP B. ART C. PAC D. All of the above ```

A. CVP

``` This type of catheter uses transducer of water manometer A. CVP B. ART C. PAC D. all of the above ```

A. CVP

``` With this type of catheter you will probably not have heart related effects? A. CVP B. Art line C. PAC D. A & C ```

B. Arterial lines are inserted in radial, axillary, brachial dorsalis pedis, femoral, not in heart veins

``` If you are hypovolemic you probably have a A. increase in fluid B. increase in blood loss C. decreased fluid D. Aortic stenosis ```

C. decrease in food

What do drugs that cause vasoconstriction due to your pressure? A. increase B. decrease C. no change

A. increased pressure

``` If you have aortic insufficiency what does this do to pressure and which catheter would you see? A. Pressure increases B. Pressure decreases C. CVP D. PAC E. Art F. A & C G. B & E ```

G. Increased pressure found with Art line

``` Arteritis is a complication of A. CVP B. PAC C. Art D. A, B ```

C. Art

If a patient receives vasopressors which catheter may be used? A. Art Catheters B. CVP C. PAC

A Art catheters

What would rt or left heart failure due to your pressure readings on your CVP? A. Increase B. Decrease C. No change

A. increase

``` When the tricuspid valve opens at end of ventricular diastole and atrial systole the pressure measured in rt atrium is A. Rt atrial pressure B. Left atrial pressure C. Rt ventricular pressure D. Left ventricular pressure ```

C. rt vent pressure or RVP

``` If you have a faulty tricuspid vale that causes regurg what catheter would you be using to see this? A. CVP B. Art line C. PAC D. Any would catch this ```

A. CVP