Exam 2 lines & ECG Flashcards
What do you need to understand about cardiac output?
Represents the amount of blood pumped by the heart in one minute
Measured as SV X HR
Measured in L/min with “normal range” of 4-8
what do you need to understand about systemic vascular resistance?
Systemic Vascular resistance is a measure of afterload resistance
Calculated as (MAP-CVP)/ CO
Normal range is 700-1500
BP =
CO (x) SVR
Central access through a vein that is close to the heart where the catheter tip is either in the SVC or IVC
central lines
what are the central line access points?
internal jugular
subclavian
cephalic
brachial
femoral
basilic
superior vena cava (tip location)
inferior vena cava (alternate tip location)
what are the placement for CVAD access?
internal jugular vein (IJ)
subclavian vein (SC)
Femoral vein
what do you need to know about an IJ access point?
Left or Right
Easiest to access
Terminates in the SVC
Moderate risk for infection due to proximity to oral secretions and neck folds
what do you need to know about a SC access point?
Left or Right
More difficult to access
Terminates in the SVC
Lower risk for infection
what do you need to know about a femoral vein access point?
Left or Right
Least desirable due to high infection risk
Terminates in the IVC
Easy to access in an emergency
what are the indications for line placement?
Meds:
vesicants/irritants to vein
central access required
multiple infusions
Fluids
Large rapid infusions
Nutrition
TNP
Lipids
Other
PIV cannot be achieved
Temporary dialysis access
Central monitoring (CVP, Swan, etc)
what are the risk of CVAD?
Bleeding
Coagulation disorders
Puncture of vessel/perf
Pneumo/hemothorax
Accidental puncture of lung during insertion of subclavian
Misplaced/mispositioned
Accidental arterial cannulation rather than venous
-IJ and femoral most common
-Use U/S guidance to prevent
-CXR confirmation before use
-Observe color of blood from line
what do you need to know for the care of CVAD?
Line patency:
Flush and check for blood return
NOT when line is being used for things like vasoactive meds
-Do not want to accidentally bolus pt with vasopressor
When blood is drawn from line, flush with 10 cc using push/pause method to prevent fibrin clots from forming at the tip of the catheter
ONLY use 10ml syringe so that the pressure difference doesn’t cause catheter to rupture
Do not use central line to draw blood cultures
-Use peripheral sticks to eliminate the possibility of getting a false positive CLABSI
what do you need to know about line care in the care of a CVAD?
Minimize access
Use curos caps
Scrub the hub
-15 seconds scrub
-15 seconds dry
Change caps after blood draw to prevent clot formation
what do you need to know about dressing/site care for care of CVAD?
Dressing should ALWAYS be clean, dry, intact
If the dressing is not PRISTINE, then it needs to be changed
Standard dressing change rule=every 7 days and as needed
Gauze underneath- change every 24 hours
Sterile procedure:
-Everyone in room is masked including family members
Use bio patch:
-Blue side up (sky is blue)- impregnated with CHG
what do you need to know about the removal for the care of a CVAD?
Biggest risk is air embolism
-If you see shortness of breath, hypotension, etc
-If it occurs, place pt on left side to try an trap remaining air in the right atrium
To remove:
-Pt lies flat/supine
-Take a deep breath with forced exhale
-Pull line quick and steady; stop if resistance
-Hold pressure with gauze for 5 minutes and place occlusive dressing
what is important to know about arterial lines?
Invasive way to monitor BP
Arterial catheter– artery=measure of pressure inside artery
Accurate readings of SBP, DBP, MAP
Non-invasive BP is not needed and if placed on the same arm of art line, will flatten the waveform while inflated
Blood draws- when frequent draws are needed (blood gases)
how do you prevent complications in arterial lines?
Use ONLY for monitoring and ABG’s
*NO MEDS
Assess often for signs of infection
Keep transducer at phlebostatic axis
Zero transducer with position changes
STRICT adherence to policies
Thrombus
Embolism
Bleeding
Used to assess perfusion pressure
MAP
Normal: 70-100 mm Hg
Indications: Poor tissue perfusion
Calculating MAP:
SBP + (2xDBP)/3
what are the cardiac arrhythmias?
Normal Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
Supraventricular Tachycardia
Atrial fibrillation
Atrial flutter
Ventricular Tachycardia (with and without a pulse)
Ventricular Fibrillation
Asystole
what does normal sinus rhythm look like?
regular
80 BPM (normal range = 60-100)
upright and reg. p-waves
0.16 sec (0.12-0.20) PR interval
one P-wave for each QRS
0.08 sec (0.04-0.12) QRS
what does sinus brady look like?
regular
50 bpm
upright and reg. P-waves
0.16 sec PRI
1 P-wave for each ORS
0.08 sec ORS
what does sinus tachy look like?
regular
130 bpm
upright/reg. P-waves
0.16 sec PRI
1 P wave for each QRS
0.04 sec QRS
what does SVT look like?
regular
280 BPM (SVT is defined as >100 bpm, typically under 150 bpm has no symptoms)
P-waves are present but difficult to see on the end of the T-wave bc of rapid rate
0.12 sec PRI
1 P-wave for each QRS (difficult to see)
0.04 QRS
what does Afib look like?
irregular
90 bpm (arterial rate is very fast and chaotic and cannot be counted)
non discernible, chaotic P-waves
PRI = none
0.08 sec ORS
what does Aflutter look like?
regular (can be irregular)
110 bpm (atrial rate is 210, typically “sawtooth” pattern of aflutter)
P-waves: flutter waves or F-waves are present
PRI: F-waves are consistent 2 for every QRS (2:1 or 3:1 is typical)
0.12 sec QRS
what does V-Tach with a pulse look like?
regular (can be slightly irregular)
200 bpm (typically between 100-250)
absent p-waves and PRI
wide and bizarre QRS (0.32 sec)
what does Vfib look like?
chaotic rhythm
chaotic rate
absent p-waves, PRI, and QRS
