Hemodynamic Monitoring

Question 1

What is actually measured with automatic blood pressure cuffs?

Answer 1

Mean arterial pressure
Systolic and diastolic are derived from an algorithm from the mean

Question 2

Normal CVP

Answer 2

2-8

Question 3

When to measure CVP

Answer 3

At end expiration

Question 4

How to measure CVP on tracing

Answer 4

Base of C wave

or

Take top and bottom of A wave and take average

Question 5

5 waves on CVP tracing and their meaning

Answer 5

A wave = atrial contraction
C wave = beginning of systole
X descent = atrial relaxation
V wave = Rapid filling of atrium
Y descent = Early ventricular filling

Question 6

CVP waveform first upward deflection following P wave on ECG

Answer 6

A wave

Question 7

CVP waveform second upward deflection following P wave on ECG (follows T wave usually)

Answer 7

V wave

Question 8

Difference between CVP waveform and wedge waveform on PA catheter

Answer 8

A and V wave will occur further after the P wave with a wedge waveform than with a CVP waveform

Question 9

Peep level above which a wedge pressure may not be accurate in mechanically ventilated patients with a PA catheter

Answer 9

> 10

Question 10

Large V waves on PA catheter tracing can mean what?

Answer 10

Tricuspid regurg
Mitral regurg

Question 11

Situation where you have large V waves but no dicrotic notch on a previously placed PA catheter

Answer 11

Malpositioned catheter that is now wedged in the setting of mitral regurg

Question 12

Large a wave in a PA catheter

Answer 12

Cannon a wave

Question 13

Cannon a wave meaning

Answer 13

Atrial contraction against a closed tricuspid valve such as with heart block or PVC

Question 14

Waves seen on RA tracing with PA catheter in atrial flutter

Answer 14

F waves (Flutter waves)

Question 15

CVP waveform pattern seen with pericardial tamponade

Answer 15

Rapid x descent and loss of y descent

Question 16

PA catheter waveform artifact where the line is flat and slowly rises

Answer 16

Overwedging (tip is not in the lumen)

Pull catheter back

Question 17

Formula for pulse pressure variation

Answer 17

PPV = 100 x (PPmax - PPmin)/PPmean

Question 18

Pulse pressure variation level that suggests fluid responsiveness

Answer 18

12-15% or more

Question 19

Increase in cardiac output in passive leg raise maneuver that suggests fluid responsiveness

Answer 19

10% or more