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Hemodynamic Monitoring Flashcards

1
Q

What is hemodynamic monitoring?

A

movement of blood flow through the cardiac chambers and pulmonary vasculature
- refers to measurement of pressure, flow and oxygenation within the CV system

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2
Q

invasive monitoring

A

arterial pressure
central venous pressure
pulmonary artery pressure monitoring
- utilizes a transducer system to convert the mechanical pumping action into a waveform on a monitor

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3
Q

most common location for a CVP on an adult?

Newborn?

A

Radial artery

Umbilical cord

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4
Q

what solution do you only use for pressure monitoring?

A

500 mL of normal saline placed on a pressure bag that is greater than 300 mmHg

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5
Q

what does it mean if blood is back flowing into the tubing?

A

the pressure bag is not on 300 or its empty

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6
Q

where is the phlebostatic axis?

A

4th ICS and mid-chest

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7
Q

indications for intra-arterial monitoring

A

pts with low CO or excessive vasoconstriction
pts on vasoactive medications
pts who need frequent ABG analysis

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8
Q

what gauge catheter is used for intra-arterial monitoring?

A

20-22 gauge

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9
Q

what does the dicrotic notch represent?

A

closure of the aortic valve

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10
Q

MAP calculation

A

S+(D*2)/3

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11
Q

how to position pt who has an air embolism?

A

left lateral down

we want the air bubble to stay in the right atrium and not progress

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12
Q

Cardiac pressure in right atrium

A

0-8

normally 6-8

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13
Q

cardiac pressure in right ventricle

A

15-25/0-8

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14
Q

cardiac pressure in pulmonary artery

A

15-25/8-15

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15
Q

cardiac pressure in left atrium

A

4-12

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16
Q

cardiac pressure in left ventricle

A

110-130/4-12

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17
Q

normal CVP

A

6-8

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18
Q

CVP utilizing water manometer value

A

7-12 cm H20

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19
Q

indications for pulmonary artery pressure monitoring

A
  • assess CV function and response to therapy
  • shock
  • assessment of fluid restrictions
  • assessment of pulmonary status
  • perioperative monitoring
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20
Q

what is a better way to evaluate the LV performance?

A

PAP monitoring

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21
Q

CVP changes are late indicators of ____?

A

LV dysfunction

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22
Q

what does PAP monitoring provide information about?

A 
CO
tissue perfusion 
blood volume 
indirectly reflects LV funcitons 
allows for venous blood specimens
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23
Q

contraindications for PAP monitoring

A
  • severe coagulation defect
  • prosthetic right heart valve
  • endocardial pacemaker
  • clients condition cannot be corrected by therapy
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24
Q

what labs to evaluate prior to insertion of PAP catheter?

A

Electrolytes (hypokalemia, hypomagnesium)

coagulation parameter

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25
how much is the max a balloon can have?
2 mL
26
when a pt has a PAP catheter, what tells you about pre-load?
- right atrial pressure | - PAWP -> indirect measurement though
27
Reason for decreased right atrium pressure
hypovolemia
28
reasons for increased right atrium pressure
- RV failure -> MI or cardiomyopathies - valvular disease - intravascular volume overload - PE, hypoxemia, COPD, ARDS - cardiac tamponade/ effusion
29
reasons for decreased right ventricle pressure
hypovolemia
30
reason for increased right ventricle pressure
COPD PE ARDS HYPOXEMIA
31
reason for decreased PAP
hypovolemia | severe tricuspid or pulmonic stenosis
32
reason for increased PAP
- PE, pulmonary HTN - hypoxemia, ARDS - COPD, sepsis - atrial or ventricular septal defects - volume overload
33
reason for increased PAOP/PCWP
- left heart dysfunction - left ventricular disease - intravascular volume overload - cardiac tamponade/effusion
34
what will you see with over wedging of the balloon
increased wave form
35
what is overweging the balloon mean
there is not enough air in the balloon
36
when do you want to measure wedge pressure
on end expiration
37
what causes improper readings of pressure lines?
- transducer not level to phlebostatic axis - loose stopcock - defective transducer - improper zero or calibration - bubble, clot or kink in the tubing
38
what does the thermistor do?
detects changes in blood temp when NS is injected into the RA and mixes with blood. changes in temp are used to calculate CO
39
CO
volume of blood ejected by the heart each minute CO= HR x SV 4-8 liters/min
40
what influences stroke volume?
preload afterload contractility
41
how do you know a pt is getting adequate perfusion?
- urine output - peripheral skin temp - mentation - capillary refill - HR
42
Cardiac index (CI)
CO/BSA | normal = 2.5-4 liters/minute/m2
43
what are signs of a pt with a CI less than 2.2?
hypoxia | buiild up of lactate
44
what is stroke volume?
amount of blood ejected by the left ventricle during each systole
45
what is preload?
amount of stretch on the myocardial muscle fibers at the end of diastole. determined by the ventricular filling volume
46
Starlings Law
the more the heart is filled during diastole, the more forcefullty it contracts
47
what is used to assess the right ventricular preload
right atrium pressure | cardiac volume pressure
48
what is used to assess the left ventricular preload
pulmonary artery occlusion pressure
49
what factors increase preload?
- fluids ingested | - IV fluids
50
what factors decrease preload?
bleeding loss of other body fluids third spacing- burns, shock orthostatic hypotension
51
Medications that affect preload
diuretics- lasix, demadex, zaroxolyn, HCTZ | vasodilators- isordil, nitro
52
what dietary and fluid factors reduce preload?
- sodium restriction | - fluid volume restriction (limit to 2 L/day)
53
what dietary and fluid factors increase preload?
IV fluids | blood administration
54
Afterload
amount of resistance the ventricles must overcome to eject blood through the semilunar valves into the aorta or pulmonary artery
55
what are primary factors affecting afterload?
systemic vascular resistance (SVR) | pulmonary vascular resistance (PVR)
56
Normal systemic vascular resistance (SVR)
900-1400
57
normal pulmonary vascular resistance (PVR)
100-250
58
what decreases SVR?
- vasodilators | - endotoxins from sepsis
59
what increases SVR?
vasoconstriction Meds- epi and norepinephrine HTN
60
why do we never want to increase PVR?
puts pt at risk for developing pulmonary overload
61
what meds decrease PVR
- arterial vasodilators - ACE-I's - CCB - vascular smooth muscle relaxants- nipride, NTG, apressoline, hyperstat
62
what would increase PVR?
- constriction - COPD, PE - CHF - hypoxemia - Acidosis
63
contractility
force with which the heart contracts
64
what decreases contractility?
``` ischemia hypoxemia hypercapnia acidosis heart failure ```
65
what increase contractility?
stimulation of the SNS
66
What meds enhance contractility?
- Dig | - dobutamine- decreases SVR too
67
how often do you zero and calibrate hemodynamic system?
at the beginning of the shift and major position changes
68
how do you maintain sterility with dressing and lines?
change every 48-96 hours and when integrity is compromised
69
when do you record readings hourly at____?
end expiration
70
how many days before a pt can be fully submerged in water after removing CVP/PAP catheter?
at least 21 days
71
what position should a pt be when removing a CVP/PAP catheter?
flat
72
how long should pressure dressing remain on after removal of catheter?
24 hours
73
indications for circulatory assist devices
- LV support while recovering from acute injury - heart requires surgical repair - end-stage HF awaiting transplant
74
Purpose of circulatory assist devices
- decreases left ventricular workload - increases myocardial perfusion - augments circulaiton
75
Clinical use for IABP
- refractory USA - short-term bridge for cardiac transplant - acute MI with ventricular septal defect, cardiogenic shock, chest pain - preop, intraop, and postop - high risk cardiology procedures
76
where is the IABP placed?
inserted via the femoral artery to descending thoracic aorta, distal to the subclavian artery
77
how do you know if IABP is migrating down?
decreased urine output because it is blocking the renal arteries
78
how do you know if IABP migrated up?
pulse in the left arm goes away
79
when do you want the balloon pump to inflate?
immediately before the dicrotic notch
80
if we keep balloon pump inflated during systole then what would we have increased?
SVR | this is bad
81
when do you want balloon pump to deflate?
immediately before systole
82
because the balloon pump is based of the dicrotic notch, what must you have?
a functioning arterial line
83
how do you see afterload?
seen in SVR number
84
how will you know the IABP is increasing coronary artery perfusion
by an improved diastolic end pressure
85
results of IABP
- increses MAP - decreased end diastolic BP - reduction in CP - increased SvO2: the high the better - improved CO
86
Ventricular assist devices (VAD)
- augments or replaces the ventricle | - shunts blood from LA to aorta
87
indications for VAD
- failure to wean from CP bypass - LV failure- awaiting transplant - Acute MI in cardiogenic shock

Process 3 (3 decks)

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