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z Su15 HEHI 1 > hemodynamic monitoring > Flashcards

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
Q

super vena cava syndrome: s/s

A

dyspnea, headache, facial/neck/upper limb edema, wicked venous distention, lightheadedness, cough due to sensation of something in throat

26
Q

pulmonary artery catheter measures

A
  • right atrial, indirect left atrial pressures
  • pulmonary artery wedge pressure
  • cardiac output, cardiac index
  • systemic, pulmonary vascular resistance
27
Q

pac: proximal lumen tip location & purpose

A

right atrium; cvp, infusion access

28
Q

pac: variable infusion port (vip) lumen tip location & purpose

A

right ventricle; fluid and drug administration

29
Q

pac: distal lumen tip location & purpose

A

pulmonary artery; pulmonary capillary (artery) wedge pressure, pulmonary artery pressure

30
Q

pulmonary capillary wedge pressure measures…

A

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
Q

systemic vascular resistance measures…

A

left ventricular afterload

use pac

32
Q

pulmonary vascular resistance measures…

A

right ventricular afterload

use pac

33
Q

cardiac output/index measures…

A

amount of blood ejected from ventricle in one minute, and co adjusted for BSA

(use pac)

34
Q

cvp: normal value

A

2- 8 mmHg

35
Q

pulmonary capillary wedge pressure: normal value

A

8 - 12 mmHg

36
Q

pulmonary vascular resistance: normal value

A

150 - 250 mmHg

37
Q

systemic vascular resistance: normal value

A

800 - 1200 mmHg

38
Q

cardiac output: normal value

A

4 - 8 L/min

39
Q

cardiac index: normal value

A

2.7 - 3.2 L/m^2

40
Q

cardiac output measurement demonstrated with…

A

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
Q

preload

A

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
Q

afterload

A

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
Q

pulmonary vascular resistance

A

right ventricular afterload (lungs)

44
Q

systemic vascular resistance

A

left ventricular afterload (aorta)

z Su15 HEHI 1 (7 decks)

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