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APEX-Equipment > EQUIPMENT-Hemodynamic monitors > Flashcards

EQUIPMENT-Hemodynamic monitors Flashcards

1
Q

What is the ideal length and width of a BP cuff bladder size

A 
Length = 80% extremity circumference
Width = 40% extremity circumference
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2
Q

Where is each of the following measure highest
SBP
DBP

A 
SBP = aortic root
DBP = dorsalis pedis artery
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3
Q

Where is each of the following measures lowest
SBP
DBP

A 
SBP = Dorsalis pedis artery
DBP = aortic root
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4
Q

Where is the pulse pressure widest and narrowest

A 
Widest = Dorsalis pedis artery
Narrowest = aortic root
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5
Q

What does the auscultation method of measuring BP rely on

A

Korotkoff sounds

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6
Q

What does the oscillatory method of BP measure

A

As the cuff is released the monitor measure the pressure fluctuation in response to arterial pulsations

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7
Q

What is the most accurate measure provided by the oscillatory BP method

A

MAP

It’s measured when the amplitude of the oscillations is greatest

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8
Q

How does a BP cuff that is too small or large affect the BP measure

A

Too small = overestimates BP, high BP (requires MORE pressure to occlude artery)

Too large = underestimates BP, low BP (requires less pressure to occlude BP)

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9
Q

Describe the relative SBP, DBP, and pulse pressure at the aortic root

A

SBP is the lowest
DBP is the highest
PP is narrowest

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10
Q

Describe the relative SBP, DBP and pulse pressure at the dorsalis pedis artery

A

SBP is the highest
DBP is the lowest
PP is widest

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11
Q

As BP is measured further from the aorta, what happens to the dicrotic notch

A

It moves further away from the systolic peak

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12
Q

What happens to a BP reading in the following positions relative to the heart
Cuff above heart =
Cuff below heart =

A

Cuff above heart = Falsely decreased

Cuff below heart = falsely increased

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13
Q

Why is a BP reading affected by position related to the heart

A

Because of hydrostatic pressure

If it is above the heart there is less hydrostatic pressure. If below the heart, more hydrostatic pressure

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14
Q

How much can a BP reading change for every 2 inches or 10 cm above or below the heart

A

2 mmHg per inch

7.4 mmHg per 10 cm

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15
Q

The BP cuff is 5 inches below the level of the heart. How is the reading affected?

A

It will be 10 mmHg higher, or falsely elevated

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16
Q 
What do the following morphology of arterial lines assess:
Peak waveform =
Trough waveform = 
Peak - trough =
Upstroke = 
Area under curve =
Dicrotic notch =
A 
Peak waveform = SBP
Trough waveform = DBP
Peak - trough = PP
Upstroke = Contractility
Area under curve = Stroke volume
Dicrotic notch = Aortic valve closure
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17
Q 
Where are the following assessed on an arterial line waveform
SBP = 
DBP = 
Pulse pressure = 
Contractility = 
Stroke volume = 
AV closure =
A 
SBP = Peak waveform
DBP = Trough waveform
Pulse pressure = Peak - trough
Contractility = Upstroke
Stroke volume = area under the curve
AV closure = Dicrotic notch
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18
Q

Where is the invasive BP monitor measuring BP

A

At the level of the transducer

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19
Q

How does an under-damped system impact BP measure (SBP, DBP, MAP)

A 
SBP = overestimated
DBP = underestimated
MAP = accurate
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20
Q

How does an over-damped system impact BP measure (SBP, DBP, MAP)

A 
SBP = underestimated
DBP = overestimated
MAP = accurate
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21
Q

What determines an optimally damped arterial monitoring system

A

Return to baseline after 1 oscillation with a square wave test

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22
Q

What assessment determines that an arterial line is under-damped

A

Baseline is re-established after SEVERAL oscillations with a square wave test

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23
Q

What are causes of an under-damped arterial monitoring system

A 
Stiff (non-compliant) tubing
Catheter whip (artifact)
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24
Q

What assessment determines that an arterial line is over-damped

A

Baseline is re-established with NO oscillations following a square wave test

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25
Q

What are 5 causes of an over-damped arterial monitoring system

A 
Air bubbles
Clot on catheter
Low flush bag pressure
Kinks
Loose connection
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26
Q

Where should the tip of a CVC terminate

A

Junction of the vena cava and RA

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27
Q

Where should the tip of a PA catheter reside

A

In the pulmonary artery, distal to the pulmonic valve

25 - 35 cm from VC junction

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28
Q

What structure is a risk for injury when access the left IJ

A

The thoracic duct causing chylothorax

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29
Q

What is the most common complication when placing CVC

A

dysrhythmias

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30
Q

What is the classic sign of PA rupture

A

hemoptysis

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31
Q

What are 3 complications of the CVC residing in the cardiac chamber

A
  1. Dysrhythmias
  2. Thrombus formation
  3. Cardiac perforation
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32
Q 
How far should the CVC be threaded to reach the VC junction from the following sites
Subclavian=
Right IJ=
Left IJ=
Femoral=
A

Subclavian= 10 cm
Right IJ= 15 cm
Left IJ= 20 cm
Femoral= 40 cm

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33
Q

What are 5 CVC complications while obtaining access

A
  1. Arterial puncture
  2. PTX
  3. Air embolism
  4. Neuropathy
  5. Catheter knot
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34
Q

What are 5 CVC complications during catheter residence

A
  1. Infection
  2. Myocardial or valvular injury
  3. Sepsis
  4. Thrombus formation
  5. Thrombophlebitis
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35
Q

What are 4 PA catheter complications while floating the catheter

A
  1. PA rupture
  2. RBBB
  3. Complete HB (w/ pre-existing LBBB)
  4. Dysrhythmias
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36
Q

Why should a PA cath not be floated in a patient with a LBBB

A

Passing the cath into the RV can cause a RBBB leading to CHB

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37
Q

What 3 patient related factors increase the risk of PA rupture

A
  1. Anticoagulation
  2. Hypothermia
  3. Advanced age
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38
Q

What 5 provider factors increase the risk of PA rupture

A
  1. Inserting cath too far
  2. Prolonged balloon inflation
  3. Chronic irritation of vessel wall
  4. Unrecognized wedge
  5. Balloon filled with liquid instead of air
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39
Q

What does the CVP waveform reflect

A

The pressure inside the right atrium

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40
Q

How many peaks and troughs occur in a CVP waveform

A 
3 peaks (a, c, v)
2 troughs (x, y)
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41
Q

What mechanical event does each point on the CVP waveform represent

A

A wave = RA contraction
C wave = tricuspid valve elevation into RA (TV closed)
X decent = down movement of contracting RV
V wave = passive RA filling
Y decent = RA empties through tricuspid

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42
Q

What is the order of the peaks and troughs of the CVP waveform

A 
A wave
C wave
X decent
V waves
Y decent
43
Q

Which valves are open and closed during the a wave

A 
Open = TV, MV
Closed = PV, AV
44
Q

Which valves are open and closed during the c wave

A 
Open = NONE
Closed = all valves
45
Q

Which valves are open and closed during the x decent

A 
Open = PV, AV
Closed = TV, MV
46
Q

Which valves are open and closed during the v wave

A 
Open = NONE
Closed = all
47
Q

Which valves are open and closed during the y decent

A 
Open = TV, MV
Closed = PV, AV
48
Q

Which part of the CVP waveform correlates with ventricular systole

A

c wave

x decent

49
Q

Which part of the CVP waveform correlates with ventricular diastole

A

v wave
a wave
y decent

50
Q

Which part of the CVP waveform correlates with atrial systole

A

a wave

51
Q

Which part of the CVP waveform correlates with atrial diastole

A

c wave
x decent
v wave
y decent

52
Q

Which part of the CVP waveform follows the EKG P wave

A

a wave

53
Q

Which part of the CVP waveform follows the QRS complex

A

c wave

x decent

54
Q

Which part of the CVP waveform follows the EKG T wave

A

v wave

y decent

55
Q

The x decent correlates with which event on the EKG

A

ST segment

56
Q 
Which electrical events do the following CVP events correlate
a wave=
c wave=
x decent= 
v wave=
y decent=
A 
a wave= after P wave
c wave= after QRS complex
x decent= ST segment
v wave= after T wave begins
y decent= after T wave ends
57
Q

How does a CVP transducer above or below the zero point affect the reading

A

Above = underestimates (LOW)

Below =overestimates (HIGH)

58
Q

At what point of the respiratory cycle is CVP read and why

A

End-expiration

At this point, extravascular pressure equals Patm and the reading isn’t affected by intrathoracic pressure

59
Q

CVP is the function of what 3 physiologic factors

A
  1. Intravascular volume
  2. Venous tone
  3. RV compliance
60
Q

What factors increase CVP

A
  1. Transducer below zero
  2. RV failure
  3. TV stenosis or regurg
  4. Pulmonic stenosis
  5. VSD
  6. Constrictive pericarditis
  7. Cardiac tamponade
  8. PEEP
  9. Hypervolemia
61
Q

What factors decrease CVP

A
  1. Transducer above zero

2. Hypovolemia

62
Q

Normal CVP range

A

1 - 10 mmHg

63
Q

What can loss of the CVP a-wave indicate

A
  1. a-fib

2. V-pacing w/ asystole

64
Q

What can a large CVP a wave indicate (8)

A
  1. Tricuspid stenosis
  2. Diastolic dysfxn
  3. MI
  4. RV hypertrophy
  5. AV dissociation
  6. Junctional rhythm
  7. PVCs
  8. Asynchronous V-pacing
65
Q

What can can a large CVP v wave indicate (3)

A
  1. Tricuspid regurg
  2. Acute increased volume
  3. RV papillary MI
66
Q

What is the morphology of the RVP waveform

Normal values

A

Systolic pressure increases
Diastolic = CVP
No dicrotic notch

Normal = (15 - 30)/(0-8)

67
Q

What is the morphology of the PA pressure

Normal values

A

Systolic remains the same as RVP
Diastolic rises
Dicrotic notch present d/t pulmonic valve closure

Normal = (15-30)/(5-15)

68
Q

What is the morphology of the PAOP waveform

Normal values

A
  • Akin to CVP of left heart (similar waveform morphology as RA CVP)
  • a wave = LA systole
  • c wave = MV closure, LV systole
  • v wave = passive LA filling

Normal = 5 - 15

69
Q

What do the events on the PAOP waveform represent
a wave=
c wave=
v wave=

A

a wave= LA systole
c wave= MV elevation and closure, LV systole
v wave= LA passive filling

70
Q

Which events on the PAOP waveform correspond to the following
LA passive filling =
LV systole =
LA systole =

A

LA passive filling = v wave
LV systole = c wave
LA systole = a wave

71
Q

For the most accurate LVEDP, where should the PAC tip reside

A

West Zone 3

P atrial > P venous > P alveolus

72
Q

Why is west zone 3 the best placement for PA readings

A

There is a continuous column of blood between the tip of the PAC and the LV (constant reading)
The arterial pressure is always highest

73
Q

3 things that suggest the tip of the PA cath is NOT in zone 3

A
  1. PAOP > PA end-diastolic pressure
  2. Nonphasic PAOP tracing
  3. Inability to aspirate blood from distal port when balloon is wedged
74
Q

What measure does PAOP reflect

A

LV-EDP/EDV

75
Q

What 4 cardiac factors can cause PAOP to overestimate LVEDP

A
  1. Impaired LV compliance (ischemia)
  2. MV dz (stenosis or regurg)
  3. L-to-R cardiac shunt
  4. Tachycardia
76
Q

What 5 pulmonary factors cause PAOP to overestimate LVEDP

A
  1. PPV
  2. PEEP
  3. COPD
  4. Pulm HTN
  5. Non-West Zone 3 placement
77
Q

What condition causes PAOP to underestimate LV-EDP/EDV

A

Aortic valve insufficiency

78
Q

How does the area under the curve correlate to CO with the thermodilution measurement method

A

The AUC is inversely proportional to the CO

79
Q

What 2 factors for measuring CO can underestimate the CO (the CO is really higher)

A
  1. Injectate volume too high

2. Injectate solution too cold

80
Q

What 4 factors for measuring CO can overestimate the CO (the CO is really lower)

A
  1. Injectate volume too low
  2. Injectate solution too hot
  3. Partially wedged PAC
  4. Thrombus on PAC tip
81
Q

What 2 conditions are unable to predict accurate CO with thermodilution method

A
  1. Intracardiac shunt

2. Tricuspid regurg

82
Q

What 4 variables is mixed venous O2 sat dependent on

A
  1. CO (L/min)
  2. O2 consumption (mL O2/min)
  3. Hgb (g/dL)
  4. Hgb sat (%)
83
Q

What are 2 pathophysiologic factors that decrease SvO2

A
  1. Increased O2 consumption

2. Decreased O2 delivery

84
Q

What are 2 pathophysiologic factors that increase SvO2

A
  1. Decreased O2 consumption

2. Increased O2 delivery

85
Q

What is the normal SvO2

A

65 - 75%

86
Q

How does SvO2 reflect CO

A

When hgb, SaO2, and VO2 are held constant, SvO2 becomes an indirect monitor of CO

87
Q

What 5 conditions decrease SvO2 by increasing O2 consumption

A
  1. Stress
  2. Pain
  3. Thyroid storm
  4. Shivering
  5. Fever
88
Q

What 3 factors decrease SvO2 by decreasing O2 delivery

A
  1. Decreased PaO2
  2. Decreased Hgb
  3. Decreased CO
89
Q

What 2 factors increase SvO2 by decreasing O2 consumption

A
  1. hypothermia

2. Cyanide toxicity (Nitropruss)

90
Q

What 3 factors increase SvO2 by increasing O2 delivery

A
  1. Increased PaO2
  2. Increased Hgb
  3. Increased CO
91
Q

Where is the best place to obtain a sample to measure SvO2

A

Pulmonary artery

It is where all blood returning from the body is mixed

92
Q

What is the formula for

A

SvO2 = SaO2 - [(VO2)/(Q x 1.34 x Hgb x 10)]

93
Q

Describe how pulse pulse contour analysis provides a measure of preload responsiveness

A

It’s a function of how stroke volume changes during the respiratory cycle w/ PPV

Changes in intra-thoracic pressuring during PPV influences stroke volume

94
Q

How does inspiration affect LV filling

A

Augments
compression of the pulmonary veins and pleural restriction impedes RV filling

Increased LV filling = increases SV

95
Q

How does expiration affect LV filling

A

It decreases
the decreased RV preload during inspiration reduces LV preload

Decreased LV filling = reduced SV

96
Q

When assessing SVV throughout the respiratory cycle, how do you know a pt requires volume

A

A greater degree of SVV throughout the respiratory cycle determines that the intrathoracic pressure affects RV filling (indicating hypovolemia)

97
Q

When can preload responsiveness be assumed when assessing SVV

A

When a 200 - 250 mL bolus improves SVV by >10%

98
Q

What 3 pulmonary factors can limit the assessment of pulse contour analysis

A
  1. Spontaneous ventilation
  2. Small Vt
  3. PEEP
99
Q

What 3 cardiac factors can limit the assessment of pulse contour analysis

A
  1. Open chest
  2. RV dysfunction
  3. Dysrhythmias
100
Q

Where is the tip of the esophageal probe positioned

A

35 cm from incisors
at the T5-T6 level
3rd sternocostal junction

101
Q

What variables does the esophageal doppler measure

A
  1. Peak velocity
  2. Flow time
  3. Mean acceleration
  4. Cycle time
  5. Stroke distance
102
Q 
What do each of the following esophageal doppler variables reflect
Peak velocity=
Flow time=
Flow time corrected=
Mean acceleration=
Cycle time=
Stroke distance=
A

Peak velocity= Contractility

Flow time= Flow time from LV during systole

Flow time corrected= Flow time indexed to HR 60

Mean acceleration= Avg speed on waveform upstroke (cm/sec)

Cycle time= Time of one cardiac cycle

Stroke distance= How far SV is pumped along aorta/beat

103
Q

What 6 factors affect the reliability of esophageal doppler measurement

A
  1. Aortic stenosis
  2. Aortic insufficiency
  3. Thoracic aorta Dz
  4. Aortic x-clamp
  5. After CPB
  6. Pregnancy
104
Q

What is a contraindication to esophageal doppler use

A

Esophageal dz (varices)

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