Exam 3 - Faithful Reproduction Flashcards

1
Q

Fluid version of Ohm’s Law

A

Pressure = Flow (Q) x Resistance (R)

R = (8)(n)(L) / (pi)(r^4)

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2
Q

What Patient Pressures do we measure

A
- Arterial P
Those measured by SWAN:
- Central Venous P
- Pulmonary Artery P
- Pulmonary capillary wedge pressure
       - Reflection of L atrial P (pre-load)
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3
Q

System pressures that we measure

A
  • Arterial line P
  • Cardioplegia line P
  • Cardiac chamber pressures
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4
Q

Pressure

A

P = Force / Area

N/m^2 = Pascal

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5
Q

Hydrostatic Pressure

A
  • Force is constant
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6
Q

Hydrodynamic Pressure

A
  • Force is varying

- Pulsatile nature of arterial blood pressure

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7
Q

Closed system

A
  • Patient and ECC for our purposes

- Flow is relatively laminar and vessel lumen is small

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8
Q

Static fluid pressure key determinant

A
  • Height (or difference in)

- Gravity and density will stay the same

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9
Q

Artifact

A
  • False signals superimposed on true signal
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10
Q

Calibration

A
  • Making sure system is accurate and can read known values
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11
Q

Catheter Whip

A
  • Movement of catheter tip in vessel due to pulsatile flow, etc.
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12
Q

Damping

A
  • Loss of energy and vibrations within monitoring system

- Think of as resistance

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13
Q

Dynamic response

A
  • System’s ability to measure physiologic pressure changes
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14
Q

Fidelity

A
  • System’s capability to faithfully reproduce physiologic event
  • System accuracy
  • can use snap test to check
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15
Q

Natural frequency

A
  • Frequency at which monitoring system vibrates when stimulated by pulsatile signals
  • Resonant frequency
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16
Q

Overshoot / Undershoot

A
  • When patient’s pressure wave has a component of the system’s natural frequency causing some kind of artifact
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17
Q

Ringing

A
  • Multiple small spikes on waveform
18
Q

Zeroing

A
  • Removing affect of atmospheric and hydrostatic pressures
19
Q

What types of pressures does our monitoring system measure

A
  • Hemodynamic P (energy in pressure wave form originating from LV)
  • Kinetic energy P (energy associated with motion of fluid)
  • Hydrostatic P (Difference in height from patient to pump)
20
Q

Summary of Invasive monitoring

A
  • Catheter (picks up pressure waves)
  • fluid column in tubing carries pressure wave to diaphragm of transducer
  • transducer is link between fluid and electronics by converting pressure signal into electrical (change in voltage)
  • electrical signal (change in voltage) is transmitted to monitor, amplified, modified, then displayed as # or pictures
21
Q

Components of Fluid-filled monitoring system

A
  • Catheter
  • Low compliance pressure tubing
  • Pressure transducer
  • Amplifier / Display
  • Flush system (3-5 ml/hour, prevent clot and backflow)
22
Q

Fourier Analysis

A
  • Think of electronics as black box
  • Takes complex wave form and breaks down into individual SIN and COS waves without changing them
  • Puts waves back together and then displays on monitor
  • Measures first six harmonics
23
Q

Fundamental frequency

A
  • 1st harmonic
  • Convert HR to freq (Hz)
    - usually just divide by 60…use dimensional analysis
  • Subsequent harmonics are just multiples of fundamental
    - Amplitude also keeps getting smaller
24
Q

Frequency response

A
  • ability of monitoring system to pass harmonics with no distortion in amplitude
  • response needed is related to degree of fidelity desired
  • usually a distortion leads to increase in amplitude
25
Q

Characteristics needed by black box

A
  • Amplitude linearity (amplitude same out as in regardless of frequency)
  • Adequate bandwidth (can cover all harmonics or range of freq’s)
  • Phase linearity (fundamental lag or lead)
    - can’t fix this….caused by black box….may/may not get amp distortion
26
Q

6 physical principles of monitoring system

A
  • Hydrodynamic pressure
  • Effect of Intertia
  • Effect of freq. response and natural freq.
  • Snap Test (dynamic response test)
  • Orientation of catheter
  • Zeroing, leveling, calibration of system
27
Q

Hydrodynamic pressure

A
  • Pressure exerted by fluid motion
  • Pulsatile in nature because of systole/diastole
  • creates range of pressures
28
Q

Effect of Inertia

A
  • Energy or pressure caused by MOVEMENT of blood
  • Monitoring system cannot respond in tandem with results
    - Which is why long tubing causes greater lag
29
Q

Effects of frequency response and natural frequency

A
  • Natural frequency = fundamental = resonant frequency
    (Natural freq decreases w/ decrease in stiff or increase in mass)
  • We want to MAXIMIZE resonant frequency to avoid overshoot
    - At least bigger than 6th harmonic….20 Hz at minimum
  • Catheter radius and stiffness affect natural frequency
    -WANT: short, stiff, wide bore cath (18 gauge)
30
Q

Underdamped

A
  • Waveform with overshoot or over-exaggeration
  • Natural frequency may also be too low
  • Looks narrow and peaked
  • Overestimates SBP and underestimates DBP
  • MAP unchanged
  • Causes: long tubing, increased vascular resistance (patient effect)
31
Q

Overdamped

A
  • Waveform looks blunted
  • Widened and slurred
  • Underestimates SBP and overestimates DBP
  • MAP does not change
  • Causes: air bubbles, over-compliant tubing, kinks, clots, small / half open stopcocks, injection ports, no flush fluid, low flush pressure
32
Q

Snap Test

A
  • Can test ability of system to faithfully reproduce pressure
  • aka fast flush test aka dynamic response test
  • pull valve….quickly let go….look at waveforms on monitor
    - can test the dampening of the system
  • Good dampening will return 1 or 2 oscillations
    - If not….check system
33
Q

William A. Gardner

A
  • Looked into effects of frequency response / dampening on monitoring equipment
34
Q

Increase dampening if….

A
  • Increase fluid viscosity
  • Decrease catheter radius
  • decrease density of fluid
35
Q

Optimal damping

A
  • 1 or 2 oscillations
  • 0.64 with a high resonant frequency
  • If increase natural freq….then we can lower dampening
  • If decrease natural freq….then we increase the dampening
36
Q

Catheter placement

A
  • Point upstream for most accurate (ABP)
  • Venous pressure may be downstream
  • Best is perpendicular but will not see with catheters
37
Q

Zeroing, leveling, calibrating

A
  • Once all set….want to Zero to room conditions
  • Make sure equipment is level with mid chest line of patient
    - otherwise might see overestimation/underestimation
38
Q

Patient factors that affect monitoring

A
  • Hypertension
  • Shock
  • Hyper-dynamic circulation
    • Sepsis, aortic regurg., atherosclerosis
  • Tachycardia (increases fundamental frequency)
39
Q

Reflected waves

A
  • Inherent in system
  • can augment true waves
    - vasoconstriction, heart failure, hypertension, aortic obstruct
  • can diminish true waves
    - vasodilation, hypovolemia, hypotension
40
Q

Factors of monitoring system we have control over

A
  • Tube length (3-4 feet)
  • No fluid on diaphragm of reusable transducers)
  • Air in system
    - Small bubbles can lower natural frequency
    - Large bubbles can overdamp
  • Tubing compliance (want stiff)
  • Luminal size of Cath (want large bore)