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hemodynamic monitoring Flashcards

1
Q

information provided

hemodynamic monitoring

A

invasive, quantitative; directly measures pressures in heart, great vessels

  • vascular capacity
  • blood volume
  • pump effectiveness
  • tissue perfusion

more accurate: bp, heart function, volume status

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2
Q

indications

hemodynamic monitoring

A
  • impaired cardiac function (acute mi, chf, cardiomyopathy)
  • shock (cardiogenic, hypovolemic, distributive)
  • decreased uop (dehydration, hemorrhage, gi bleed, burns, surgery)
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3
Q

components

hemodynamic monitoring

A

pressure-monitoring system:

  • catheter with infusion system (non-distensible tubing, fluid with pressure bag)
  • transducer
  • monitor
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4
Q

pressure transducer

A

part of hemodynamic monitoring, converts pressure into analog electrical signal visualized on monitor

goal: transmit pressure with very little disturbance before reaching transducer to increase accuracy

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5
Q

phlebostatic axis: where

A

4th intercostal space, mid-center, mid-axillary line

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6
Q

phlebostatic axis: what

A

precise anatomical point of original of hemodynamic pressures being measured; right atrium of the heart

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7
Q

arterial line: purpose

A

direct, continuous measurement of arterial bp; rapid and accurate reading

systolic, diastolic, mean, heart rate

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8
Q

arterial line: preferred & okay

A

radial preferred, femoral okay

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9
Q

modified allen’s test: purpose

A

check of arterial competency, perform before all art line placement and arterial sampling

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10
Q

modified allen’s test: steps

A
  1. patient elevates forearm/hand and makes fist for 30 seconds
  2. occlude ulnar and radial arteries
  3. patient opens hand - should appear blanched
  4. release ulnar pressure - hand should become pink
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11
Q

dicrotic notch

A

seen on arterial waveforms; captures pressure upon aortic valve closure after systolic contraction

should be higher than diastolic bp

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12
Q

systolic bp

A

amount of pressure/force generated by left ventricle to distribute blood into aorta with each heart contraction

  • indicator of how effectively heart pumps, vascular tone
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13
Q

diastolic bp

A

amount of pressure/force against arterial walls during heart relaxation phase

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14
Q

arterial waveforms: overdamping

A

pressure waves blocked before reaching transducer; sbp underestimated + dbp overestimated

consider: incorrect tubing, air bubbles, positioning, kinking, clotted catheter, loss of flush pressure

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15
Q

arterial waveforms: underdamping

A

pressure waves exaggerated before reaching transducer; sbp overestimated + dbp underestimated

consider: tubing too long or too small, occluded vessel

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16
Q

arterial wave forms: overdamping –> sbp + dbp

A

sbp underestimated

dbp overestimated

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17
Q

arterial wave forms: underdamping –> sbp + dbp

A

sbp overestimated

dbp underestimated

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18
Q

interpretation of data and waveforms related to hemodynamic monitoring falls on whom?

A

THE BEDSIDE NURSE!!!!!!!!!!!!!!!!!!!

19
Q

peripheral lines can’t be used for hemodynamic monitoring - why?

A

characteristics of catheter; too narrow, false elevated reading, overdamped waveforms

20
Q

central venous catheter: indications

A
  • lack of suitable peripheral access
  • advanced venous access for infusions, frequent blood draw or blood/med administration
  • advanced medical procedures (plasmapheresis, dialysis, aquapheresis)
  • HEMODYNAMIC MONITORING: CVP!
21
Q

central venous catheter: insertion sites

A

internal jugular
subclavian
femoral
umbilical

VEINS!

22
Q

central venous pressure (cvp) monitors … ?

A

right atrial pressure = right sided preload

  • amount of blood returning to heart
  • degree of muscle fiber stretch within right ventricle prior to systole

always read at end expiration

23
Q

always read cvp when?

A

at end expiration

24
Q

super vena cava syndrome

A

lack of venous return due to obstruction of superior vena cave; many possible causes but one can be central venous catheter placement
- backed up blood = edema = facial changes

25
super vena cava syndrome: s/s
dyspnea, headache, facial/neck/upper limb edema, wicked venous distention, lightheadedness, cough due to sensation of something in throat
26
pulmonary artery catheter measures
- right atrial, indirect left atrial pressures - pulmonary artery wedge pressure - cardiac output, cardiac index - systemic, pulmonary vascular resistance
27
pac: proximal lumen tip location & purpose
right atrium; cvp, infusion access
28
pac: variable infusion port (vip) lumen tip location & purpose
right ventricle; fluid and drug administration
29
pac: distal lumen tip location & purpose
pulmonary artery; pulmonary capillary (artery) wedge pressure, pulmonary artery pressure
30
pulmonary capillary wedge pressure measures...
preload of left ventricle - amount of blood returning to left heart, degree of muscle fiber stretch within left ventricle prior to systole; end diastolic pressure (use pac)
31
systemic vascular resistance measures...
left ventricular afterload | use pac
32
pulmonary vascular resistance measures...
right ventricular afterload | use pac
33
cardiac output/index measures...
amount of blood ejected from ventricle in one minute, and co adjusted for BSA (use pac)
34
cvp: normal value
2- 8 mmHg
35
pulmonary capillary wedge pressure: normal value
8 - 12 mmHg
36
pulmonary vascular resistance: normal value
150 - 250 mmHg
37
systemic vascular resistance: normal value
800 - 1200 mmHg
38
cardiac output: normal value
4 - 8 L/min
39
cardiac index: normal value
2.7 - 3.2 L/m^2
40
cardiac output measurement demonstrated with...
thermodilution curve; 10cc room temp saline slammed into right atrium via pac and temp of blood arriving at wedged pac tip measured - indicates cardiac output
41
preload
degree of myocardial fiber stretch at end of diastole just before contraction - results from volume contained within ventricle at end of diastole - determined by amount of blood returning to heart from both venous AND pulmonary systems
42
afterload
pressure or resistance that ventricles must overcome to eject blood through semilunar valves and into peripheral blood vessels pulmonary vascular resistance (lungs) + systemic vascular resistance (aorta)
43
pulmonary vascular resistance
right ventricular afterload (lungs)
44
systemic vascular resistance
left ventricular afterload (aorta)

z Su15 HEHI 1 (7 decks)

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