Hemodynamic monitoring Flashcards
What location is the transducer placed for arterial line monitoring?
Phlebostatic axis, 4th intercostal midaxillary
What benefits do arterial lines serve over the NIBP?
Second by second reading
Able to obtain arterial blood samples
What does the dicrotic notch signify on an arterial line wave form?
Aortic valve closes (diastolic phase)
How do you “zero” the transducer?
Place transducer at phlebostatic axis, making sure no air bubbles
Turn the stop cock off to the patient and remove cap if needed
Press “zero” on monitor
Replace cap on transducer
Turn stopcock back on to the patient
How many oscillations should you see before returning to wave form?
No more or no less than 3 oscillations
If you see none, overdamping
If you see over 5, underdamping
How many ML an hour is delivered of normal saline Heparin infused saline with an ART line?
3 ml/hr
What are 3 common causes of an overdamped ART line waveform?
Kinked line
Air in line
Pressure bag overfilled
What does overdamping mean?
Too much pressure
Wave form will look more like rounded tops with no dicrotic notch
What does underdamping mean?
Too little pressure
Wave form will be sharp peaks with dicrotic notch lower on the down slope
What are 2 common causes of an underdamped ART line waveform?
Pressure bag not full
Noncompliant tubing
Air in line
What does the saline bag need to be pressurized at for an ART line?
300 mmhg with a pressure bag
What are some benefits of a central venous line?
Rapid fluid replacement
Medication administration
Rapid access to central circulation
Used for hemodynamic monitoring
What are we measuring with central Line?
Preload
What are we measuring with a swan-ganz catheter (pulmonary artery catheter)?
Right heart preload
Right heart afterload
Left heart preload
How many ML of air is used to inflate the distal tip of the balloon in a Swanz-Ganz line?
No more than 1.5 cc of air
While obtaining a pulmonary capillary wedge pressure (PCWP), do not leave balloon inflated longer than how many seconds and how many breaths?
No more than 15 seconds and no more than 3 breaths.
When should you take a reading off the PA catheter?
At the end of exhalation.
Can you use the PA line for fluid or medication administration?
No, it is for monitoring and lab samples only. Use the proximal port for infusions and fluid.
Should you keep the balloon inflated with a PA catheter while transporting? Why or why not?
No, you should deflate the balloon to prevent an inadvertent wedge pressure. Balloon size increases at altitude.
If the diacrotic notch is on the left side of the waveform, what does this indicate?
Right ventricle waveform (tricuspid valve closing)
If the dicrotic notch is on the right side of the waveform, what does this indicate?
Pulmonary artery waveform (pulmonic valve closing)
What is the progression of the Swan-Ganz catheter through the heart?
Pass through the right atrium
Into the right Ventricle
Final destination is Pulmonary Artery
Balloon inflated to get wedge pressure.
What is a normal Central Venous Pressure (CVP or RAP)?
2-6 mmHg and measures right heart preload
What is a normal right ventricular Pressure (RV or RVP)?
Systolic 15-25 mmHg
Diastolic 0-5 mmHg
What is a normal Pulmonary Artery pressure (PA or PAP)?
Systolic 15-25 mmHg
Diastolic 8-15 mmHg
Used to measure afterload on left side
What is a normal pulmonary artery wedge pressure (PAWP)?
8-12 mmHg
Measures right heart afterload and left heart preload
What is a normal Coronary perfusion pressure (CPP)? What is the formula for Coronary Perfusion pressure?
50-60 mmHG
DBP-PAWP
What is the Normal Cardiac output?
4-8 L/min
What is a normal cardiac index?
2.5-5.0 L/min
In terms of PA lines, what is a catheter whip and what do you do to treat it?
Catheter whip is when the distal tip of the PA line is left in the Right ventricle causing the tip to “beat” the inside of the ventricle. You correct this by laying patient on their side, inflate cuff to 1.5 cc of air and have them cough until the tip is back in the pulmonary artery. If this does not work, Pull the catheter back into the right atrium, but while doing so, make sure tip is deflated.
What is unique about neurogenic shock and the changes you may see in the vital signs of your patient?
The decrease in HR and BP
How can you determine if the patient is in Hypovolemic Shock when it comes to monitoring hemodynamic?
Decreased CO/CI
Decreased CVP
Decreased PCWP
Increased SVR
How can you determine if the patient is in Cardiogenic Shock when it comes to monitoring hemodynamic?
Decreased CO/CI
Increased CVP
Increased PCWP
Increased SVR
How can you determine if the patient is in Neurogenic Shock when it comes to monitoring hemodynamic?
Normal or decreased CO/CI Normal or decreased CVP Normal or decreased PCWP Decreased SVR Decreased HR
How can you determine if the patient is in Septic Shock when it comes to monitoring hemodynamic?
Increased CO/CI
Normal or decreased CVP
Normal or decreased PCWP
Decreased SVR
What could a high PAWP with sepsis be linked to?
ARDS
What are indications for an IABP (intra-aortic balloon pump)?
Acute MI with cardiogenic shock or post CABG
Cardiogenic shock
What are contraindications of an IABP?
Aortic insufficiency/disease
Peripheral vascular disease
Aortic regurgitation
When does the balloon inflate for an IABP?
During diastole and aortic valve closure
Where is the IABP placed?
Inserted into the femoral artery directed towards the heart.
Distal tip 2-3 cm below the left subclavin artery
Proximal end above renal artery
How do you verify placement of the IABP?
Palpating a left radial pulse
Ensure adequate urine output
Chest X-Ray
What would you do if your unit lost power during IABP therapy?
Manually pump every 3-5 minutes to prevent blood from clotting on the balloon
What would you suspect if you saw brown or rust colored flakes in the IABP tubing?
Tubing has ruptured.
What 2 timing errors are the most dangerous?
Early and late deflations
What does an early inflation waveform look like?
Has a “U” shape at the top of the waveform
What does a late inflation waveform look like?
HAs a “w” shape at the top of the waveform
What does an early deflation waveform look like?
Has a Cliff shape in the waveform
What does a late deflation waveform look like?
Has a widened appearance shape from the dicrotic notch.
Which timing error is the most deadly?
Late deflation
