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I & M > CVP Monitoring > Flashcards

CVP Monitoring Flashcards

1
Q

What is CVP?

A

Central venous pressure

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2
Q

What is preload?

A

Preload = tension in muscle

How displaced/stretched the muscle is from its resting position

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3
Q

What is preload formula?

A

T = r x V / 2 x C

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4
Q

How do you assess volume status by the above preload formula?

A

By looking at how efficient the muscle of the RV is

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5
Q

According to the Frank-starling principle, what pressure will the CVP reflect if elasticity remains the same and you have to use the equation to determine a number?

A

LVEDV

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6
Q

What 2 ways can you look at and determine RVEDV?

A

TTE (transthoracic ECHO)

TEE (transesophageal ECHO)

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7
Q

If something is less compliant, it will have higher or lower pressure?

A

HIgher pressure

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8
Q

When placing a CVP catheter, how will you know you enter the RA?

A

The pressure waveform will give 2 distinct parts per cardiac contraction
(AC waveform and XVY waveform)

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9
Q

What are the letters corresponding to a CVP waveform?

A 
A
C
X
V
Y
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10
Q

What is the A waveform?

A

Atrial contraction

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11
Q

What is the C waveform?

A

Ventricular contraction that shows an upward peak from tricuspid valve bulge from increase in P from ventricle

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12
Q

What is the X waveform?

A

Nadir wave that is late ventricular ejection once Pulmonary valve has opened pulling the tricuspid valve into chamber

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13
Q

What is the V waveform?

A

Is the passive return of blood into the RA from the systemic circulation

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14
Q

What is the Y waveform?

A

Opening of the tricuspid valve that begins the push of blood into the right ventricle

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15
Q

What parts of waveform are considering to be in systole?

In diastole?

A

CXV in systole

AY in diastole because they are filling

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16
Q

The A wave of CVP waveform marks what?

A

End of diastole

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17
Q

The C wave of CVP waveform marks what?

A

Beginning of systole

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18
Q

The V wave if present because of what mechanical event?

A

Filling of atrium

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19
Q

How is CVP measured and charted by anesthesia ?

A

As a mean pressure

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20
Q

As far as breathing patterns are concerned, when should CVP measurements be taken?

A

End expiration

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21
Q

When recording CVP pressures during spontaneous ventilation, what should mean CVP be?

A

14 mmHg

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22
Q

When recording CVP pressures during positive pressure ventilation, what should mean CVP be?

A

8 mmHg

23
Q

Cannon wave are seen with what physiological occurrence?

A

Conduction blocks

24
Q

Cannon waves are reflective waves in pressure that can be seen when the atrium contracts against a closed valve, this will produce what kind of CVP reading?

A

Falsely high CVP readings

25
Q

Regurgitant CV waves can be seen when you have what?

A

Faulty valves that allow back-flow (regurg) or high pressures (stenosis)

26
Q

How can you diagnose A fib on a CVP waveform?

A

Loss of a A wave and very prominent C wave

27
Q

How can you distinguish between A fib and A flutter on a CVP waveform?

A

A flutter will look like periods of A fib with periodic cannon A waves

28
Q

Will CVP alone tell you how to proceed with fluid maintenance and replenishment?

A

NO

CVP is getting a ballpark number for pressure and then up to you as to how to proceed with interventions and treatments

29
Q

In the central line packets, what are suturing needles also called?

A

K needles

30
Q

Look at the picture of tray contents and be able to recognize and name each

A 
EX: 
J wire
Finder needle
Catheter
Lidocaine
ETC
31
Q

What is the syringe called that allows you to find the vein and feed the J wire directly through the stopper without ever having to disconnect the syringe from it?

A

Wire-thru syringe

32
Q

What does the ASK stand for in central line kits?

A

Arrow select kits

33
Q

What pertinent information is on the outside of the central line kit that you need to check before opening it?

A

:Flow equivalent lumen
:How many lumens
:Size of catheter in french
:Length of catheter in cm

34
Q

What are 2 most common entry points for insertion of a CVP?

A

RIght IJ

RIght sub-clavian

35
Q

The velocity of a pressure waveform is roughly equivalent to what?

A

Speed of sound

36
Q

When placing a mid-RIJ central line, what is the distance to the RA?

What size length kit should you use?

A

20 cm

so should use 16cm central line to not fully enter RA

37
Q

What factors are considering when picking out the appropriate sized kit length?

A

Patients height

NOT AGE OR WEIGHT

38
Q

Which lumen is the largest lumen of the central line?

A

Distal lumen and is usually 14 g

39
Q

T OR F: It is acceptable to release the J wire at any time when placing into the patient?

A

FALSE

it is never acceptable to release the J wire once it has entered the patient

40
Q

What size are most J wire outer diameter ? What size cannula will this fit through?

A

0.028 inches J wire

will fit through 18g cannulas

41
Q

For placing a Right IJ cannula, where should the needle be inserted and what should be palpated ?

A

Should be inserted at the apex of the triangle formed by the 2 heads of the sternocleidomastoid muscle with needle tip directed towards ipsilateral nipple. The carotid artery should be palpated before needle entry

42
Q

What are the anatomical borders of the triangle you shoot for during IJ insertion?

A

Clavicular head of sternocleidomastoid muscle, sternal head of “” muscle, Clavicle

43
Q

When placing a central line via ultrasound, how do you know which one is the vein on the screen?

A

The vein is compressible

44
Q

What will help increase the diameter of the IJ for easier placement of central line?

A

Asking patient to perform Valsalva maneuver

45
Q

What is the largest risk when placing a subclavian vein central line?

A

Risk of pneumothorax

46
Q

What is different when placing a catheter into EJ?

A

EJ lies on top of Sternocleidomastoid muscle

47
Q

In the arm, what is the vein of choice when placing a central line?

A

Basilic vein

48
Q

What mnemonic is used for the femoral vein placement of a central line?

A

NAVY or NAVAL from lateral to medial
(nerve artery vein Y formed by legs)
(nerve artery vein air lymph node)

49
Q

What is distance from IJ to RA and PA?

A 
RA = 20 cm
PA = 45 cm
50
Q

What is distance from femoral vein to RA and PA?

A 
RA = 40 cm
PA = 65 cm
51
Q

What is distance from subclavian to RA and PA?

A 
RA = 10 cm
PA = 40 cm
52
Q

The guidewire will always come out what connector?

A

Distal connector

53
Q

What must always be done to ensure proper placement on a central line and should be included in pre-checklist to do list?

A

Make sure cap is off the distal connector to allow J wire/guidewire to fully exit connector

54
Q

I not sure how much he could possibly ask about this one, but maybe just be familiar with different parts of kit.

A

I do hate you all for giving me this subject PS

I & M (37 decks)

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