Hemodynamic monitoring

Question 1

Blood Flow through the heart

Answer 1

RT Atrium
RT Ventricle
Lungs = oxygen
LT Atrium
LT ventricle
Body

Question 2

Cardiac output

Answer 2

CO=SV X HR
4-8 Liters

Question 3

Cardiac Index

Answer 3

BSA measurement
2.2-4 l/m/m2
cardiac output/BSA

Question 4

MAP

Answer 4

70-105 mmHg
SBP +2(DBP)/3

Question 5

Pulmonary Artery Diastolic Pressure (PAD)

Answer 5

4-12 mmHg
Elevated PAD caused by conditions that affect the left side of the heart
LT heart failure, MI
low PAD caused by inadequate venous return to the heart- low preload caused my shock or dehydration, sustained tachycardia

Question 6

Pulmonary Artery Systolic Pressure (PAS)

Answer 6

18-25 mmHg
Elevated in conditions that increase Right ventricle afterload of PVR (pulmonary HTN, Lung disease, hypoxemia)

Question 7

Right Atrial Pressure (RAP)

Answer 7

2-8 mmHg
directly measures right ventricle preload
fluid volume excess or processes that increase PVR, increase RAP
ex: HF, Pulmonary HTN, Cardiac tamponade
decrease in RAP is related to fluid loss r/t absolute burns or relative losses

Question 8

Stroke Volume (SV)

Answer 8

60-150 ml/beat

Question 9

Systemic Vascular Resistance (SVR)

Answer 9

800-1200
indirectly measures LT sided afterload
Left ventricular Afterload
the amount of resistance that the LT ventricle must overcome to pump blood out of the heart and body
elevated SVR can create a high myocardial oxygen demand and decrease SV and CO

Question 10

Central Venous Pressure (CVP)

Answer 10

2-8 mmHg
indicator of central blood volume
in critical care sometimes increase CVP to deliver O2 to body
reflects RT heart preload and RAP, but does Not directly reflect anything on LT side since catheter lies outside of heart

Question 11

complications associated with insertion of CVC

Answer 11

pneumothorax
hematoma
infection
minimally invasive

Question 12

ART line

Answer 12

used to monitor BP
respiratory instability and respiratory insufficiency

Question 13

advantages of ART line

Answer 13

minute to minute BP monitoring
increased accuracy of monitoring
Obtaining frequent ABG’s

Question 14

disadvantages of ART line

Answer 14

Peripheral artery BP may not clearly indicate central BP
occlusion of vessels, can lead to ischemia and possible necrosis of tissue distal to insertion site

Question 15

ART lines can be placed in the following areas

Answer 15

Radial Artery
Brachial Artery
Femoral Artery
Axillary Artery

Question 16

Pulmonary Artery Catheters

Answer 16

Indicates health of heart, circulation, and lung health
inserted into neck or chest into RT atrium to RT ventricle and circles through Pulmonary Artery
Preload can be measured with this device

Question 17

what is preload

Answer 17

the stretching occurring in the heart at the end of diastole when heart relaxes, r/t fluid left in heart

Question 18

pulmonary artery wedge pressure

Answer 18

indirectly measures LT ventricle preload
not located inside the heart
insert balloon creates occlusion on systole, during diastole can feel if fluid is flowing backwards from LT ventricle

Question 19

pulmonary vascular resistance (PVR)

Answer 19

directly measures RT sided afterload
is an estimate of Right ventricular afterload

Question 20

absolute losses

Answer 20

burns
diuresis
hemorrhage
vomiting
these decrease RAP

Question 21

relative losses

Answer 21

Shock
Vasodilation
Third Spacing
(fluid is NOT in vessel and non existent to CV system)
causes decrease in RAP

Question 22

what is the best way to treat issues with RAP?

Answer 22

treat the underlying problem
increased RAP- restrict fluid, restrict sodium, diuretics (furosemide)Lasix’s
Decreased RAP- provide fluids (crystalloid), transfusions

Question 23

Pulmonary Artery Pressure (PAP)

Answer 23

reflects both right and left heart pressures and is read like a BP (PAS)/(PAD)
normal 20-30/ 4-12

Question 24

what makes a PAP inaccurate?

Answer 24

mitral stenosis
sustained tachycardia
COPD
PE

Question 25

causes of elevated SVR

Answer 25

hypovolemia (in a healthy patient), cardiac failure

Question 26

causes of decreased SVR

Answer 26

systemic vasodilation
medications
states of shock (sepsis)