Exam 3 part 1 Flashcards
a blood pressure cuff that is too small will:
incorrectly OVERESTIMATE the true blood pressure
the diastolic blood pressure measured with an automated BP cuff using the oscillometric method will be:
approximately 10 mm Hg higher when compared to direct arterial measurement
which artery is the principal source of blood flow to the hand?
ulnar
risk of brachial artery cannulation
damage to the median nerve
risks of femoral artery cannulation
local and retroperitoneal hematoma
which artery is commonly used during emergencies and low flow states?
femoral
when interpreting a CVP waveform, the end of systole best coincides with the:
C wave
represents bulging of the tricuspid valve into the atrium during the beginning of systole
a wave of the CVP waveform
atrial contraction
X descent of the CVP waveform and when does it occur?
atrial relaxation
occurs during systole
V wave of the CVP waveform
filling of the atrium when the tricuspid valve is closed
Y descent on the CVP waveform
when the tricuspid valve opens and the atrium starts to empty
CVP tracing with prominent C-V waves suggests
tricuspid regurgitation
a much larger C wave represents blood flowing retrograde into the right atrium due to the incompetent tricuspid valve. the increased V wave size is due to the retrograde flow continuing throughout systole.
loss of Y descent on the CVP tracing with elevated filling pressures
cardiac tamponade
note: elevated filling pressures in a trauma patient is a red flag, it is unlikely that a bleeding trauma patient (i.e. chest stab wounds) would have elevated filling pressures
Which of the following is a key step in arterial cannulation for blood pressure monitoring?
A. Use of a large-bore catheter.
B. Avoidance of aseptic techniques.
C. Cannulation of the femoral artery in all cases.
D. Monitoring for complications such as thrombosis and infection.
D. Monitoring for complications such as thrombosis and infection.
Which characteristic is indicative of an over-dampened arterial pressure waveform?
A. High systolic peak.
B. Exaggerated dicrotic notch.
C. Falsely narrow pulse pressure.
D. Tall, sharp waveform.
C. Falsely narrow pulse pressure.
Which of the following is a common complication associated with CVP catheter placement?
A. Pulmonary embolism.
B. Arterial puncture.
C. Myocardial infarction.
D. Cerebral edema.
B. Arterial puncture.
What is a potential complication of pulmonary artery catheter insertion?
A. Hypertension.
B. Pneumothorax.
C. Hyperglycemia.
D. Kidney failure.
B. Pneumothorax.
ulse pressure variation (PPV) is most reliable under which condition?
A. Patient in atrial fibrillation.
B. Spontaneous breathing.
C. Mechanical ventilation without spontaneous breaths.
D. Use of vasodilators.
C. Mechanical ventilation without spontaneous breaths.
You are preparing to insert a radial artery catheter in a patient with a history of vasospastic arterial disease. What step should you take to minimize complications?
A. Choose a smaller gauge catheter.
B. Avoid use of heparinized saline.
C. Utilize ultrasound guidance.
D. Select the femoral artery instead.
C. Utilize ultrasound guidance.
During surgery, the arterial pressure waveform shows signs of over-damping with a falsely narrow pulse pressure. What could be a potential cause?
A. Incorrect zeroing of the transducer.
B. Air bubbles in the tubing.
C. Excessive systemic vascular resistance.
D. Low cardiac output.
B. Air bubbles in the tubing.
A patient with severe emphysema requires CVP monitoring via the internal jugular vein. Why is this site preferred over the subclavian vein?
A. Lower risk of infection.
B. Easier access for repeated measurements.
C. Less risk of pneumothorax.
D. Better patient comfort.
C. Less risk of pneumothorax.
Before inserting a pulmonary artery catheter in a patient with a left bundle branch block (LBBB), what precaution should you take?
A. Administer prophylactic antibiotics.
B. Ensure availability of a defibrillator.
C. Monitor for ventricular arrhythmias.
D. Pre-treat with antiarrhythmic drugs.
B. Ensure availability of a defibrillator.
A mechanically ventilated patient in the ICU has a PPV of 20%. What does this indicate about the patient’s fluid status?
A. The patient is likely hypovolemic.
B. The patient is likely hypervolemic.
C. The patient has normal fluid status.
D. The PPV value is inconclusive.
A. The patient is likely hypovolemic.
in the normal CVP tracing, where does the tricuspid valve close?
between the a-wave and c-wave
the tricuspid valve closes after atrial contraction (a-wave) and before ventricular contraction (which has two components – the c wave and x-descent). thus, it occurs between the a-wave and c-wave
which of the following conditions will mask the pulsus paradoxus commonly seen in cardiac tamponade?
a. positive pressure ventilation
b. mucous plug
c. stridor
d. chronic obstructive pulmonary disease (COPD)
which of the following landmarks is appropriate for gaining subclavian venous access?
a. needle insertion medial to the sternocleidomastoid muscle, just medial to the carotid artery
b. needle insertion above the inguinal ligament, lateral to the femoral artery.
c. needle insertion at the midpoint of the clavicle with the needle directed toward the suprasternal notch
d. needle insertion at the lateral border of the clavicular head of the sternocleidomastoid muscle in the interscalene groove
c. needle insertion at the midpoint of the clavicle with the needle directed toward the suprasternal notch
a. = IJV (but LATERAL to the carotid)
b. = femoral (but MEDIAL to the fem artery)
d. = interscalene nerve block
which nerve is at greatest risk of suffering an injury during arterial catheter insertion into the brachial artery?
median nerve
a “flush test” is performed to assess damping of an arterial line pressure-monitoring system. a system with an appropriate dynamic response will have which of the following responses to rapid flushing?
a. one large oscillation before return to baseline
b. one large and one small oscillation before return to baseline
c. one large and 3 small oscillations before return to baseline
d. a square wave
e. several large and small oscillations before return to baseline
b. one large and one small oscillation before return to baseline
natural frequency
how fast the pressure monitoring system vibrates when excited by a signal, such as the arterial pressure pulse or the pressure signal caused by a fast-flush test.
damping coefficient
measures how quickly the oscillations of a shock-excited system dampen and eventually come to rest
which of the following is most likely to produce underdamping in an arterial pressure monitoring system?
a. excessive tubing length
b. bubbles in the tubing
c. kink in arterial catheter
d. thrombus at the tip of the arterial catheter
a. excessive tubing length
obstruction of the arterial catheter with a thrombus, kink, or bubbles can cause OVERdamping.
which component of the central venous pressure waveform is most likely to be absent in a patient with a junctional rhythm?
a wave
a patient with severe tricuspid regurgitation is expected to have what CVP tracing abnormality?
tall c-v wave, diastole
a square wave test is performed to measure the dynamic response of a radial arterial line. two oscillations are seen before the tracing returns to baseline. what best describes the state of the arterial pressure monitoring system?
adequately damped
What is the insertion site for the brachial artery?
Medial to the biceps tendon
What is the insertion site for the axillary artery?
Junction of pectoral is and deltoid muscle
How does the systolic pressure measured at the dorsalis pediatric artery differ from that measured in the aorta?
Higher systolic pressure estimates
Three components of an overdamped arterial waveform
- Slurred upstroke
- Absent dicrotic notch
- Loss of fine detail
Pulsus parvus
Waveform is small in amplitude (aortic stenosis)
Pulsus tardus
Delayed peak in systole (aortic stenosis)
Bisferiens pulse
Two systolic peaks (aortic regurg)
Spike-and-dome
Mid-systolic obstruction (hypertrophic cardiomyopathy)
Pulsus alterans
Alternation of larger and smaller pressure waves that vary with the respiratory cycle
Generally associated with severe LV systolic dysfunction or AS
Pulsus paradoxus
Exaggerated variation in arterial pressure (>10-12 mm Hg) during quiet breathing. AKA an inspiratory fall in the systolic blood pressure greater than 10 mm Hg.
Common and important sign in cardiac tamponade!
Or anything that involves large swings in intrathoracic pressure: bronchospasm, severe airway obstruction, dyspnea
Which site is most successful for CVP monitoring?
Right internal jugular vein
Which CVP monitoring site is associated with high risk of pneumothorax?
Subclavian
