Hemodynamic Monitoring Flashcards
accuracy in hemodynamic monitoring depends on these things
**positioning at the phlebostatic axis (4th intercostal space, midaxillary line*nipple line)
**zeroing reference (negate atmospheric pressure, “0” stopcock)
dynamic response testing
3 types of hemodynamic monitoring
A-lines
cvp/rap - central venous catheters (RAP/CVP)
pa catheters - pulmonary artery
primary goal of hemodynamic monitoring
assess and trend tissue perfusion adequacy
2 ways to assess tissue perfusion
noninvasive and invasive
noninvasive measures for tissue perfusion
BP, JVD
invasive measures for tissue perfusion
right atrial pressure (aka CVP)
pulmonary artery pressure
arterial pressure
tell me about lactate levels (non-invasive monitoring)
end product of cellular metabolism under anaerobic conditions
trend values
venous or arterial
***indications for invasive monitoring
decreased cardiac output
ineffective tissue perfusion
fluid volume excess or deficit
indications for noninvasive monitoring
low BP - hypotensive
flat JVD
decreased urine output
complications of invasive monitoring
infection
thrombosis
what can alter lactate levels
liver dysfunction
what 5 pcs compromise invasive monitoring systems
invasive catheter tubing transducer flush system bedside monitor pressure bag normal saline
The nurse returns from the cardiac catheterization laboratory with a patient following insertion of a pulmonary artery catheter and assists in transferring the patient from the stretcher to the bed. Prior to obtaining a cardiac output, which action is most important for the nurse to complete?
Zero reference the transducer system at the phlebostatic axis.
why do we use a-lines or arterial lines
measure arterial BP - its more accurate (sepsis)
frequent ABG’s (easy access)
most frequent insertion site for Aline
radial artery
before sticking in the radial artery what must we do
Allen’s test - checks for collateral circulation
how do we do an Allen’s test
make fist
occlude radial and ulna artery
release one see if hand turns pink
complications of an Aline
thrombosis
***can you put drugs through an Aline
no NEVER - strictly for monitoring, can draw labs
mgmt of Aline
assess extremities every 2 hrs
any pain, numbness, color, temp, tingling
Which nursing actions are most important for a patient with a right radial arterial line? (Select all that apply.)
Checking the circulation to the right hand every 2 hours
Maintaining a pressurized flush solution to the arterial line setup
Monitoring the waveform on the monitor for dampening
RAP/CVP normal pressures
2-6 mmHG
what does the RAP/CVP monitor
central venous pressure(CVC)/right atrial pressure(PAC)
complications of RAP/CVP
infection
pneumothorax or hemothorax
