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Process 3 > Hemodynamic Monitoring > Flashcards

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
Q

how much is the max a balloon can have?

A

2 mL

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26
Q

when a pt has a PAP catheter, what tells you about pre-load?

A
  • right atrial pressure

- PAWP -> indirect measurement though

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27
Q

Reason for decreased right atrium pressure

A

hypovolemia

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28
Q

reasons for increased right atrium pressure

A
  • RV failure -> MI or cardiomyopathies
  • valvular disease
  • intravascular volume overload
  • PE, hypoxemia, COPD, ARDS
  • cardiac tamponade/ effusion
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29
Q

reasons for decreased right ventricle pressure

A

hypovolemia

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30
Q

reason for increased right ventricle pressure

A

COPD
PE
ARDS
HYPOXEMIA

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31
Q

reason for decreased PAP

A

hypovolemia

severe tricuspid or pulmonic stenosis

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32
Q

reason for increased PAP

A
  • PE, pulmonary HTN
  • hypoxemia, ARDS
  • COPD, sepsis
  • atrial or ventricular septal defects
  • volume overload
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33
Q

reason for increased PAOP/PCWP

A
  • left heart dysfunction
  • left ventricular disease
  • intravascular volume overload
  • cardiac tamponade/effusion
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34
Q

what will you see with over wedging of the balloon

A

increased wave form

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35
Q

what is overweging the balloon mean

A

there is not enough air in the balloon

36
Q

when do you want to measure wedge pressure

A

on end expiration

37
Q

what causes improper readings of pressure lines?

A
  • transducer not level to phlebostatic axis
  • loose stopcock
  • defective transducer
  • improper zero or calibration
  • bubble, clot or kink in the tubing
38
Q

what does the thermistor do?

A

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
Q

CO

A

volume of blood ejected by the heart each minute
CO= HR x SV
4-8 liters/min

40
Q

what influences stroke volume?

A

preload
afterload
contractility

41
Q

how do you know a pt is getting adequate perfusion?

A
  • urine output
  • peripheral skin temp
  • mentation
  • capillary refill
  • HR
42
Q

Cardiac index (CI)

A

CO/BSA

normal = 2.5-4 liters/minute/m2

43
Q

what are signs of a pt with a CI less than 2.2?

A

hypoxia

buiild up of lactate

44
Q

what is stroke volume?

A

amount of blood ejected by the left ventricle during each systole

45
Q

what is preload?

A

amount of stretch on the myocardial muscle fibers at the end of diastole.
determined by the ventricular filling volume

46
Q

Starlings Law

A

the more the heart is filled during diastole, the more forcefullty it contracts

47
Q

what is used to assess the right ventricular preload

A

right atrium pressure

cardiac volume pressure

48
Q

what is used to assess the left ventricular preload

A

pulmonary artery occlusion pressure

49
Q

what factors increase preload?

A
  • fluids ingested

- IV fluids

50
Q

what factors decrease preload?

A

bleeding
loss of other body fluids
third spacing- burns, shock
orthostatic hypotension

51
Q

Medications that affect preload

A

diuretics- lasix, demadex, zaroxolyn, HCTZ

vasodilators- isordil, nitro

52
Q

what dietary and fluid factors reduce preload?

A
  • sodium restriction

- fluid volume restriction (limit to 2 L/day)

53
Q

what dietary and fluid factors increase preload?

A

IV fluids

blood administration

54
Q

Afterload

A

amount of resistance the ventricles must overcome to eject blood through the semilunar valves into the aorta or pulmonary artery

55
Q

what are primary factors affecting afterload?

A

systemic vascular resistance (SVR)

pulmonary vascular resistance (PVR)

56
Q

Normal systemic vascular resistance (SVR)

A

900-1400

57
Q

normal pulmonary vascular resistance (PVR)

A

100-250

58
Q

what decreases SVR?

A
  • vasodilators

- endotoxins from sepsis

59
Q

what increases SVR?

A

vasoconstriction
Meds- epi and norepinephrine
HTN

60
Q

why do we never want to increase PVR?

A

puts pt at risk for developing pulmonary overload

61
Q

what meds decrease PVR

A
  • arterial vasodilators
  • ACE-I’s
  • CCB
  • vascular smooth muscle relaxants- nipride, NTG, apressoline, hyperstat
62
Q

what would increase PVR?

A
  • constriction
  • COPD, PE
  • CHF
  • hypoxemia
  • Acidosis
63
Q

contractility

A

force with which the heart contracts

64
Q

what decreases contractility?

A 
ischemia
hypoxemia
hypercapnia
acidosis
heart failure
65
Q

what increase contractility?

A

stimulation of the SNS

66
Q

What meds enhance contractility?

A
  • Dig

- dobutamine- decreases SVR too

67
Q

how often do you zero and calibrate hemodynamic system?

A

at the beginning of the shift and major position changes

68
Q

how do you maintain sterility with dressing and lines?

A

change every 48-96 hours and when integrity is compromised

69
Q

when do you record readings hourly at____?

A

end expiration

70
Q

how many days before a pt can be fully submerged in water after removing CVP/PAP catheter?

A

at least 21 days

71
Q

what position should a pt be when removing a CVP/PAP catheter?

A

flat

72
Q

how long should pressure dressing remain on after removal of catheter?

A

24 hours

73
Q

indications for circulatory assist devices

A
  • LV support while recovering from acute injury
  • heart requires surgical repair
  • end-stage HF awaiting transplant
74
Q

Purpose of circulatory assist devices

A
  • decreases left ventricular workload
  • increases myocardial perfusion
  • augments circulaiton
75
Q

Clinical use for IABP

A
  • 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
Q

where is the IABP placed?

A

inserted via the femoral artery to descending thoracic aorta, distal to the subclavian artery

77
Q

how do you know if IABP is migrating down?

A

decreased urine output because it is blocking the renal arteries

78
Q

how do you know if IABP migrated up?

A

pulse in the left arm goes away

79
Q

when do you want the balloon pump to inflate?

A

immediately before the dicrotic notch

80
Q

if we keep balloon pump inflated during systole then what would we have increased?

A

SVR

this is bad

81
Q

when do you want balloon pump to deflate?

A

immediately before systole

82
Q

because the balloon pump is based of the dicrotic notch, what must you have?

A

a functioning arterial line

83
Q

how do you see afterload?

A

seen in SVR number

84
Q

how will you know the IABP is increasing coronary artery perfusion

A

by an improved diastolic end pressure

85
Q

results of IABP

A
  • increses MAP
  • decreased end diastolic BP
  • reduction in CP
  • increased SvO2: the high the better
  • improved CO
86
Q

Ventricular assist devices (VAD)

A
  • augments or replaces the ventricle

- shunts blood from LA to aorta

87
Q

indications for VAD

A
  • failure to wean from CP bypass
  • LV failure- awaiting transplant
  • Acute MI in cardiogenic shock

Process 3 (3 decks)

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