Exam 2 cardiac hemodynamics Flashcards
What is important to know about cardiac output?
represents the amount of blood pumped by the heart in 1M
measured as SV X HR
measured in L/M with “normal range” of 4-8
What is cardiac index?
adjust for pt size by dividing cardiac output by BSA. normal range is 2-4 L/M
What is important to know about systemic vascular resistance?
is a measure of afterload resistance
calculated as (MAP-CVP)/ CO
normal range is 700-1500
indirectly effects stroke volume of the heart
What is the 1st line of treatment of HTN and hypotension?
hemodynamics (fluid management)
Use of medications without treating hypo or hypervolemia will be ineffective and potentially dangerous.
what is the assessment of fluid volume?
SVR
CVP
HR
BP
how does the pt look?
What are the fluids to use in hemodynamics?
colloids vs. crystalloids
colloids: BP and albumin
colloids have higher tonicity allowing them to stay in the vasculature
Crystalloids consist of fluids like D5W, NS, and LR. has lower tonicity causing more of the volume to “third space.”
what are the indications for central line use?
inadequate peripheral venous access
meds & TPN: Ca+ chloride, K+ chloride, chemotherapy, and blood transfusion
hemodialysis
frequent blood draws
central venous/arterial monitoring
What are the risk and complications with CVC?
-infection (central line associated blood stream infection (CLABSI))
-arterial puncture
-air embolism
-hematoma
-thrombosis
-hemothorax
what do you need to know about preventing complications with CVC?
STRICT adherence to policies
-dressing changes
-cap changes
-blood draws
-other precautions
what are the indications for arterial line use?
need for REAL-TIME, ACCURATE BP MONITORING
-critical illness, vasoactive meds, hemorrhage, high risk procedures
inability to use non-invasive monitoring (bariatric burns)
frequent ABG’s
what are the risk and complications of arterial line use?
infection
hemorrhage
air embolism
impaired circulation
what do you need to know about preventing complications in arterial lines?
use ONLY for monitoring and ABG’s
NO MEDS
- assess often for signs of infection
-keep transducer at phiebostatic axis
-zero transducer with position changes
-STRICT adherence to policies
represents right atrial pressure (venous return to the heart/preload)
central venous pressure
what causes an increased CVP?
fluid overload
cardiac tamponade
R heart disfunction/failure
what causes a decrease CVP?
dehydration
volume loss
venous dilation
Provides real-time systolic, diastolic, and mean arterial pressure (MAP)
arterial lines
where is arterial line placement?
radial, brachial, femoral
what will mismanagement of transducer do in arterial lines?
Mismanagement of transducer will give inaccurate readings and dampened waveforms
Used to assess perfusion pressure
mean arterial pressure (MAP)
what is normal MAP?
70-100 mmHg
what is the indication for MAP?
poor tissue perfusion
how do you calculate MAP?
SBP+ (2xDBP)/3
Difference between SBP & DBP
pulse pressure
what is normal pulse pressure?
30-100
what is the indication for pulse pressure?
wide PP (more than SBP) - aortic incompetence
narrow PP (more than DPB) - hypovolemia
what is the placement of a pulmonary artery cath/swan ganz?
Inserted into the SVC - Right atrium - Right ventricle - Pulmonary artery
what are the indications for PA cath use?
Measurement of: CO, SV, SVR
Measurement of: RAP & PAP
Acute pulmonary hypertension
PE
Cardiac tamponade
what is the precise management of PA Cath?
Right arterial pressure (RAP)/CVP
Pulmonary artery pressure (PAP)
Pulmonary wedge pressure (PCWP)
Cardiac Output/Cardiac Index (CO/CI)
what are the risk and complications of PA cath use?
Infection- Central Line Associated Blood Stream Infection (CLABSI)
Arterial puncture
Air embolism
Hematoma
Thrombosis
Hemothorax
Pneumothorax
