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Adult II Complex > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

Purpose of Hemodynamic Monitoring

A
  1. Assess heart function, fluid balance, effects of fluids and drugs on CO
  2. Assess resistance of systemic and pulmonary arterial vasculature and O2
    content, delivery and consumption
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2
Q

Noninvasive

A

-Cuff pressures
-Pulse Ox

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3
Q

Mean Arterial Pressure (MAP)

A

pressure in our arteries during 1 cardiac cycle. It tells us how well our vital organs are being perfused.

Normal range: 70-105 mmHg

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4
Q

How to calculate MAP

A

Systolic BP+ 2 (Diastolic BP) / 3

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5
Q

Trouble shooting Pulse ox

A

1) Assess waveform
2) Assess pulse rate as compared to ECG heart rate
3) Best location
4) Inaccurate readings

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6
Q

Invasive Pressure Monitoring

A

Pressure monitoring system

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7
Q

Pressure monitoring system Equipment

A

-Catheter
-Transducer with noncompressible pressure tubing (KNOW WHERE THE TRANDUSER LEVELS GOES IN 4TH INTERCOSTAL SPACE, MID AXILLARY (Heart level))
-Pressurized normal saline flush bag (300mmhg pressure)
-cable and monitor

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8
Q

For pressure bags

A

you need to label each tubing and bag

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9
Q

Optimal dynamic response. When you flush an art line it..

A

creates a square in the ECG, called square wave test

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10
Q

Other factors that impact accuracy of pressure readings

A

a) Confirm no blood or air in line
b) Client position (head elevation 0-45 degrees)

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11
Q

Arterial blood pressure monitoring purpose

A

Measure continuous systemic blood pressure directly in artery (More accurate than blood pressure cuff)

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12
Q

Arterial blood pressure uses

A

(1) Evaluate interventions continuously, including vasoactive medications (norepinephrine, phenylephrine, epinephrine, vasopressin)
(2) Obtain arterial blood samples
(3) If pt is in shock or hypotension or post op pt might get this.
(4) Need a more accurate measure than blood pressure cuff)

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13
Q

Locations for arterial blood pressure monitoring

A

(1) Radial* MOST COMMON LOCATION

(2) Other arteries utilized: femoral, axillary, brachial

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14
Q

Normal values for Systolic and diastolic pressure and MAP

A

(1) Systolic pressure (SBP) 80-100
(2) Diastolic pressure (DBP) 60-80
(3) Mean arterial pressure (MAP) GOAL IS GREATER THAN 65 mmHg

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15
Q

Insertion of Arterial blood pressure monitoring

A
  1. Perform Allen’s test (a way to measure blood flow in hand)
  2. Set up monitoring system (Flush line, zero, perform square wave test, set high and low alarms)
  3. Immobilize insertion site
  4. Apply transparent dressing waveform (they stitch it, so you must assess site just like IV. Assess for bleeding, circulation, color of hand)
  5. Label tubing as arterial line
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16
Q

Management of arterial blood pressure monitoring

A
  1. Verify arterial waveform
  2. Maintain continuous fluid irrigation; check every 1 to 4 hours
  3. Assess insertion site and area distal to the site hourly
  4. Assess for bleeding at catheter site or from tubing
    connections
  5. Observe ECG and pressure tracing with
    dysrhythmias.
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17
Q

Complications to monitor for with aterial blood pressure monitoring

A

1) *hemorrhage
2) infection
3) thrombus formation
4) *neurovascular impairment (emergency and must be reported)

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18
Q

Removal of Arterial blood pressure monitoring

A

a) Apply direct pressure over and above insertion site
10 minutes or until bleeding has stopped. Apply pressure sterile dressing as needed. If pt has low platelets you hold for a long time.

b) Continue to assess hemostasis maintained

19
Q

Central venous access devices (CVADS) purpose

A

Rapid administration of IV fluids, blood and blood products, parenteral nutrition and medications.

  • When pt doesn’t need anymore, get with MD to take out. Need Xray for placement bc may cause pneumothorax
20
Q

Risk from CVADs

A

systemic infection, leakage of fluids

21
Q

Types of CVADS

A
  1. centrally inserted cathether
  2. nontunneled (wasnt tunneled under skin)
  3. tunneled catheter (surgically placed under skin)
  4. PICC
  5. Implanted ports (port-a-cath)
  6. Midline cath
22
Q

Nontunneled caths can

A

Can measure RAP (right atrial pressure) or CVP (central venous pressure). RAP and CVP are used interchangeable. NORMAL for ICU pts is 7-14.

23
Q

Tunneled caths provide

A

b) Provides catheter stability and reduces infection risk
c) After site heals, client does not need dressing

24
Q

PICC are used for

A

a) Used for vascular access for 1 week to 6 months
b) Advantage lower risk infection, fewer insertion related complications
c) Risk: deep vein thrombosis and phlebitis (if happens, occurs within 7-10 days of insertion
d) Not take BP or draw blood in arm with PICC

25
Q

Implanted ports

A

a) Access with special needle (Huber needle) tip deflected to prevent damage to port
b) Can directly inject into reservoir or through an established IV
c) Monitor for infiltration

26
Q

Midline Cath

A

can stay in place up to 4 weeks

27
Q

Procedure for insertion of centrally or peripherally inserted catheters – guidelines to prevent CLABSI

A

1) Verify Informed consent
2) Set up monitoring system (RAP)
3) Position – supine or trendelenberg (15-30 degrees) unless
femoral insertion
4) Perform time-out
5) Hand hygiene, don cap, mask, sterile gown and gloves, eye
protection
6) Skin prep with chlorhexidine and allow to air dry
7) Drape client using sterile technique
8) Secure Catheter and apply transparent occlusive dressing
9) Verify placement with X-ray or fluoroscopy if inserted in
Interventional Radiology
10) Daily review of necessity of the line and prompt removal
when unnecessary. If saline locked and not using, needs to be taken out.

28
Q

Decreased RAP/CVP

A

indicate low
volume

Action: fluid bolus or vasopressors

29
Q

Increased RAP/CVP

A

increased volume,
increased intrathoracic pressure or pulmonary pressures increased

Action: treat cause

30
Q

Do not use a newly placed CVAD until

A

until tip position is
verified with x-ray (After x-ray, need order saying its ok to use)

31
Q

Before hanging a new medication of fluid

A

verify compatibilites

32
Q

CVAD removal

A

a) Nurses may be allowed to remove PICC and nontunneled catheters
b) Place supine
c) Remove dressing and suture if applicable
d) Have client valsalva during last 5 to 10 cm of catheter removal.
e) Immediately apply pressure to site with sterile gauze
f) inspect catheter tip
g) After bleeding stopped, apply sterile dressing

33
Q

Catheter related infection (local or systemic) MOST COMMON

A

a) Presentation -Local: redness, tenderness, purulent drainage, warmth, edema; Systemic: fever, chills, malaise
b) Actions: local- culture drainage, apply warm moist compresses, remove catheter if needed; Systemic – obtain blood culture, give antibiotics and antipyretics prescribed, remove catheter if needed. *PRIORITY: CALL DOCTOR TO GET LINE OUT!!!!!!!!!!

34
Q

Pulmonary artery catheters – pulmonary artery pressures

A

-Measures RAP/CVP (make sure CVP is connected to brown port), PAP (PAS, PAD, PAM), PWP, CO/CI, SVO2, and temp

-Obtain information about right and left sides of the heart

-Obtain information about preload, afterload, and contractility

-Manage hemodynamically unstable client

35
Q

Pulmonary artery catheters locations

A

Inserted through subclavian, internal or external jugular, or femoral vein

36
Q

Pulmonary artery normal values

A

1) PA systolic pressure - amount of pressure needed to open pulmonic valve;
2) PA diastolic pressure – Under normal conditions reflects left ventricular end-diastolic pressure

37
Q

To obtain measurements with pulmnary artery cath

A

1) Zero, level to phlebostatic axis with head elevation
0-45 degrees
3) PAP: at end expiration
5) Never inflate balloon with more than 1.5 mL
6) Do not inflate for more than four respiratory cycles
or 10–15 seconds
7) Leave balloon lumen deflated and locked position
except for intermittent reading

38
Q

Pulmonary artery cath - Utilize proximal lumen to

A

measure RAP, infuse IV fluids,
sample blood, infuse IV meds

39
Q

Pulmonary artery cath Utilize distal lumen to

A

measure PA pressures – lumen not
used for IV fluids, only irrigation fluids

40
Q

Arterial oxygen saturation (SaO2)

A

represents the actual amount of oxygen bound to Hgb divided by the maximum amount oxygen that could bind to Hgb; measure with pulse oximetry

41
Q

Mixed venous oxygen saturation (SVO2)

A

reflects the oxygen saturation of Hgb in venous blood returning to heart; Requires PA catheter

42
Q

Central venous oxygen saturation (ScVO2)

A

utilizes central line and specialized monitor

43
Q

Minimally invasive hemodynamic monitoring

A

Arterial pressure based cardiac output monitoring (APCO) provides a minimally invasive method to measure CO; arterial catheter and monitor permit continuous calculation of CO

Adult II Complex (15 decks)

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