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Monitoring > Hemodynamic monitoring > Flashcards

Hemodynamic monitoring Flashcards

1
Q

What is the ideal length of the bladder size of a BP cuff? Width?

A

Length - 80%
Width - 40%

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2
Q

If the cuff is too small, what will the BP read?

A

Overestimates because it takes more pressure

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3
Q

If the cuff is too large, what will the BP read?

A

Underestimates because it takes less pressure

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4
Q

Where is the widest pulse pressure when measuring BP?

A

Foot

SBP is the highest
DBP is the lowest

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5
Q

Where is the narrowest pulse pressure when measuring BP?

A

Aortic root

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6
Q

If the BP cuff is above the heart, the BP reading will be;

A

Falsely decreased

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7
Q

If the BP cuff is below the heart, the BP reading will be;

A

Falsely increased

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8
Q

Over dampened or under dampened? SPB is overestimated and DPB is underestimated?

A

Under dampened

** many oscillations

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9
Q

What causes an under dampened art line?

A

Stiff, non compliant tubing

Catheter whip

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10
Q

Over dampened or under dampened? SPB is underestimated and DPB is overestimated?

A

Over dampened

** no oscillations

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11
Q

What causes an over dampened art line?

A

Air bubble
Clot
Low pressure bag pressure
Kinks
Loose connection

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12
Q

Is the MAP accurate with an over or under dampened art line?

A

YES

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13
Q

How far should a central line be advanced through the R IJ to achieve correct placement?

A

15 cm

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14
Q

What is at increased risk when placing a Left central line?

A

Puncturing the thoracic duct

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15
Q

When are dysrhythmias most common to occur? Treatment?

A

While obtaining access

Pull back

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16
Q

When does the indcidence of infection increase?

A

After three days

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17
Q

When shouldn’t you float a PAC?

A

A patient with a LBB because it floating the PAC may trigger a RBB which would put the patient into complete heart block

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18
Q

What is the classic presentation for pulmonary artery rupture?

A

Hemoptysis

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19
Q

What increases the risk of a pulmonary rupture?

A

Anticoagulation
Hypothermia
Advanced age

Using liquid in the balloon
Chronic inflation of balloon
Unrecognized wedging

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20
Q

Distances of catheter insertion ***

A
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21
Q

What is the A wave on the cvp pressure waveform?

A

RA contraction

First upstroke

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22
Q

What is the c wave on the cvp pressure waveform?

A

Tricuspid closure - RV contraction

Second upstroke

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23
Q

What is the x wave on the cvp pressure waveform?

A

RA relaxation

first major downslope

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24
Q

What is the v wave on the cvp pressure waveform?

A

Ra passive filling

25
Q

What is the y wave on the cvp pressure waveform?

A

RA empties into RV through open tricuspid valve

26
Q

What increases RA pressures

A

Low transducer
Hypervolemia
Tricuspid stenosis or regug
VSD
PEEP
Tamponade
Constrictive pericarditis
RV failure
Pulmonic stenosis

27
Q

When should CVP be measured? Where?

A

End expiration

4th intercostal space, mid anteroposterior level

28
Q

What is a normal CVP?

A

1-10

29
Q

What is CVP measurement a function of?

A

Intravascular volume

Venous tone

RV compliance

30
Q

Factors that decrease CVP?

A

High transducer
Hypovolemia

31
Q

When is the a wave lost on a CVP?

A

Afib

V pacing if the underlying rhythm is asystole

32
Q

What increases the amplitude of the a wave on the CVP?

A

Tricuspid stenosis
Diastolic dysfunction
myocardial ischemia
Lung disease
AV dissociation
Junctional rhythm
V pacing - asynchronous
PVCs

33
Q

What causes a large V wave?

A

Tricuspid regurg

Acute increase in volume
RV papillary muscle ischemia

34
Q

What changes do you see when the PA catheter enters the RV?

A

Systolic pressure increases
Diastolic is equal to CVP

35
Q

What changes do you see when the PA catheter enters the Pulmonary artery?

A

Systolic stays the same
Diastolic pressure rises
Dicrotic notch is seen

36
Q

What changes do you see when the PA is wedged?

A

Same waveform as the CVP but with the L side of the heart

37
Q

What are the pressures in the RVP?

A

15-30

0-8

38
Q

What are the pressures in the PAP

A

25/10

39
Q

What are the pressures in the PAOP (wedge)

A

5-15

40
Q

Which lung zone should the tip of the PA catheter be in?

A

Zone 3

41
Q

What suggests the PA tip is not in zone 3?

A

Can’t draw blood because it is wedged

Nonphaseic PAOP tracing

PAOP > PA end diastolic

42
Q

What causes PAOP to underestimate LVEDV?

A

aortic valve insufficiency

43
Q

What causes PAOP to overestimate LVEDV?

A

Everything but aortic valve insufficiency and correct placement

44
Q

Which situation underestimates cardiac output obtained by thermodilution ?

A

High injectate volume or cold

45
Q

When can thermodilution not predict ?

A

Intracardiac shunt
Tricuspid regurgitation

46
Q

Where and how should the thermodilution be administered?

A

5% dextrose or NS through the proximal port in under 4 seconds

47
Q

When should thermodilution be used versus continuous cardiac output?

A

in unstable patients

48
Q

Why is a PA catheter necessary to measure SvO2?

A

Need a collection of all venous blood

SVC
IVC
Coronary sinus

49
Q

What is a normal SvO2? What is needed to measure?

A

65-75%

CO
VO2
Hgb
SaO2

50
Q

What is pulse contour analysis? How does it work?

A

Indicator on how the patient will respond to a 250mL bolus of fluid

Measures the stroke volume variation during the respiratory cycle

or

the change in intrathoracic pressure

51
Q

If the SVV is >13% will the patient respond to a 250mL bolus? <13%?

A

yes they will respond if the SVV is > than 13%

52
Q

What limits the use of SVV?

A

Spontaneous Ventilation
PEEP
Dysrhythmias
Open chest
RV dysfunction
Small Tv

53
Q

What are contraindications to using esophageal doppler?

A

Esophageal disease

54
Q

How much will the BP change for every 10cm? every inch?

A

10cm - 7.5mm

Inch - 2mm

55
Q

What does the upstroke on an Aline tell you?

A

the contractility

56
Q

What does the dicrotic notch tell you on an Aline?

A

closure of the Aortic valve

57
Q

How is the pulse pressure calculated on an Aline?

A

Peak - trough

58
Q

How does the cvp waveform correlate to the electrical activity of the heart

A
59
Q
A

Monitoring (10 decks)

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