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mod 2 CC > hemodynamic monitoring > Flashcards

hemodynamic monitoring Flashcards

1
Q

3 aspects of hemodynamic monitoring

A
  1. arterial pressure
  2. central venous pressure
  3. central venous O2 sat (ScvO2)
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2
Q

principles of invasive monitoring nurses can:

A
  1. assess cardiac function
  2. circulating blood vol status
  3. physiological responses to medical and nursing interventions
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3
Q

invasive catheters 2

A

dependent on pressures

  1. ART line
  2. CVC
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4
Q

flush solution

A

NS

sometime heparin solution but can cause HIT

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5
Q

pressure bag

A

manual inflate to 300mmHg to ensure that blood from tubing doesnt go back up the tubing of pressure system

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6
Q

pressure tubing set

A
  • is non-compliant to produce accurate reading
  • allows continuous flow rate of 3ml/hr (under pressure)
  • has fast flush device - allows bolus and flushes to clear blood during set up or to obtain blood sample
  • typical- has 3 way stopclocks. one for blood sample, the other for zeroing
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7
Q

transducer

A
  • senses BP in artery or vein
  • BP transducer is translated into electrical signal to monitor
  • also provides tracing (waveform) = BP and used for ECG monitoring
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8
Q

ECG

A

Electrocardiogram

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9
Q

why do you calibrate equipment? 2

A

to ensure accuracy of 2 baseline measurements
1. calibrate to atmospheric pressure “zeroing”

  1. determine the phlebostatic axis for transducer height placement “leveling the transducer”
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10
Q

leveling the transducer

A
  • aligning the transducer with level of atrium
  • line up air filled interface with the LEFT atrium to correct for changes in hydrostatic pressure in blood vessels above or below level of heart
  • a carpenters level can be used to ensure phleb axis reference point
  • if change in position, must do again
  • if transducer is too high = false low BP reading
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11
Q

phlebostatic Axis

A

physical reference point on chest 4th intercoastal space to mid- axillary along with mid- anterior/posterior

  • aprox level of atria
  • can be pole mounted or arm mounted
  • transducer must always be leveled to the phlebostatic axis
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12
Q

if the transducer is below the phleb axis…

A

we can think of it as the fluid in the system exerting extra weight on the transducer with reads as pressure inaccurate high readings

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13
Q

why do we calibrate equip?

A

to insure accuracy and 2 baseline measurements are needed

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14
Q

what is calibrating system to atmospheric pressure

A

zeroing

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15
Q

zeroing transducer

A

calibrate to atmospheric pressure

  • 3 way stopcock nearest transducer is turned to open to air and close to PT and flush system
  • monitor adjusts to zero (instead of atmospheric pressure which is 760mmHg)
  • zero provides baseline
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16
Q

leveling step-by-step

A
  1. PT supine with HOB 0-60 degrees. doc HOB for reference
  2. locate the phlebostatic axis
    - 4th intercost space
    - axilla midline btwn anterior and posterior where X is
  3. place carpenter level btwn phlebo axis and air filled interface (air reference stop cock) of transducer
    - move transducer up/down IV pole until air-filled interface is centered
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17
Q

why do you position PT supine and reference HOB

A

to ensure accuracy of the readings

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18
Q

why locate the phlebo axis?

A

physical point of level of transducer reduces the effect of hydrostatic forces on transducer

ensures consistency of readings

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19
Q

why place carpenters level and move transducer up/down?

A

to ensure transducer air reference stopcock is leveled with the level of the right atrium

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20
Q

when will you see a flat waveform on the monitor

A

when you open the stopcock to air

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21
Q

why do you open to air?

A

the monitor can use atmospheric pressure as reference

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22
Q

steps to zeroing

A
  1. open stopcock to air- see flat waveform
  2. push and release zero button
  3. turn stopcock back to monitoring position and observe waveform
    “open to PT, off to air”
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23
Q

where is the phlebo axis

A

level of the R atrium

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24
Q

what if the transducer is below the phlebo axis?

A

inaccurate high reading

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25
Q

when we level the phlebo axis, we level the?

A

transducer

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26
Q

to prime and flush the pressure line we?

A

pull the fast flush device

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27
Q

what is the purpose of zeroing the transducer

A

allows the monitor to set zero for atmospheric pressure

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28
Q

how is the numeric value of the hemodynamic pressure transferred to the bedside monitor

A

catheter, fluid sensation, transducer, electrical signal, cable, monitor, display

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29
Q

arterial BP monitoring

A
  • provides accurate continuous monitoring, waveform for visualizing systolic and diastolic pressures and arterial access for blood sampling
  • involves cannulation of major preiph artery
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30
Q

nursing responsibility for ART line

A
  • accuracy of monitor system
  • troubleshooting
  • apply knowledge obtained from monitor

-monitor, integrity of lines, set up system, accuracy of values of and waveform, alarm limits,

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31
Q

the transducer on a hemodynamic monitoring system is leveled to the PT’s phlebostatic axis. which is located where?

A
  1. level of the right atrium

2. 4th intercostal space mid-axillary

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32
Q

when does the transducer need to be zeroed

A
  1. whenever there is a disconnection between the transducer and monitor
  2. in order to obtain accurate readings
  3. to negate the effects of atmospheric pressure
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33
Q

you notice your PT’s arterial pressure waveform has a steep upstroke, an obvious dicrotic notch and a trough. you would?

A

consider this normal

34
Q

the hemodynamic assess framwork is? 3

A
  1. is part of the O2 supply and demand framework
  2. focuses primarily on heart rate and the determinants of CO
  3. incorporates data from hemodynamic monitoring systems

NOT- isolation to direct PT assessment

35
Q

why do we use the radial artery for ART line?

A

easy access and low risk bc of collateral circulation

36
Q

ART BP and cuff BP can be what difference

A

5-10mmHG

37
Q

ART BP is related to?

and also affected by?

A

CO!

and SNS and compensatory mechanisms of periph vasoconstriction

38
Q

BP within normal limits does not necessary indicate?

A

adequate CO

39
Q

when we interpret BP and MAP we need to consider:

A
  1. normal BP and MAP
  2. previous
  3. current interventions (meds)
  4. other hemodynamic assess interventions
  5. underlying patho
40
Q

when we look at waveform, we look at:

A
  1. upstroke
  2. dicrotic notch
  3. down stroke

also look at ECG (heart beat)

41
Q

what does the waveform look like on poorly perfused beat?

A

the waveform is smaller

42
Q

when the ART and ECG waveforms change?

mainly when the ECG wave changes

A

the electomechanical event in the heart has changed , which alters the ventrical contraction = decreased SV or blood ejected

43
Q

decreased SV =

A

decreased CO

44
Q

PVC

A

premature ventricular contraction

from poor perfusion or non=perfused beat

45
Q

what is it called if the transducer is oversensitive?

A

overshooting, fling, underdampened

46
Q

what does overshooting waveform look like?

A

sharper upstroke of normal ART waveform

47
Q

what do you do if you notice a sharper upstroke on ART wave?

A

do fast flush square waveform test.

will show multiple oscuilltations after pulling the fast flush instead of just two

48
Q

what is it called when transducer is undersensitive?

A

dampened waveform

every pulse/flow will not be sensed by cath tip

BP 80/50 (norm 120/80)

49
Q

what happens to the waveform if dampened?

A

sharp upstroke becomes lost and and occasionaly notch becomes lost.

50
Q

what is the first thing you do if you notice dampened?

A

assess PT, then square waveform

51
Q

how do you know the ART waveform is demonstrating decreased CO?

A

amongst regular waveforms, smaller ones would be visible

52
Q

what would be the possibility of blood backing up the ART line from site? 3

A
  1. tubing disconnect
  2. pressure bag deflated
  3. inadequate flush solution
53
Q

if you see flat line on ART monitor you? 3

A
  1. ABC
  2. check site
  3. check tubing
54
Q

risks associated with invasive ART monitor

A
  1. infection
  2. decreased tissue perfusion
  3. embolus d/t thrombus at catheter tip
  4. hemorrhage
55
Q

blood sample for CVC

for ART?

A

CVC- use stopcock and use trow away sample

ART- has no stopcock and has VAMP which reduced blood exposure

56
Q

after removal of ART line, how long do youput pressure?

A

5-10 min

57
Q

CVC monitor reflects

A

volume of blood at right ventricular end diastolic pressure or right sided preload

direct communicates R atrium

58
Q

where do you place CVC for monitoring

A
  1. IJ ** (internal first then external if not)- bld flow is higher
  2. subclavian
  3. bracial when not moitoring?
59
Q

when do you use CVP : 3

A

when PT has significant alteration in fluid vol

  1. hypovolemia- hemorrhage
  2. hypervolemia- fluid overload
  3. require rapid diuresis
60
Q

you can use the square waveform test with a CVC to test?

A
  1. as guide in fluid vol replacement
  2. and assess impact of diuresis
    - watch CVP go from 10 to normal level (2-6) then can stop diuretic therapy
61
Q

when do you use subclavian vein?

A

if longer than 5 days needed

62
Q

2 major risks with CVC insertion

A
  1. pneumothorax - if misplaced puncture lung pleura

2. dysrrhythmias - if too far it tickles atrium

63
Q

CVP normal value?

A

2-6

64
Q

where do you read the CVP waveform?

A

at end-expiraton

65
Q

where can you read the CVP waveform? 2

A
  1. the monitor

2. manual from the print out strip

66
Q

why do you look at CVP at end-expiration?

A

it eliminates the influence of intrathoracic pressure during ventilation

at end-expire, the intrathoracic pressure approximates atmospheric pressure and

CVP readings are less likely to be influenced by pulmonary pressures that may be generated in the ventilation cycle.

67
Q

PT position for CVP measurements

A

supine flat or supine HOB 0-60

68
Q

how can CVP indicate right sided preload

A

during diastole, R atrium and vent equilibriate

69
Q

in order to have accurate CVP results, intrathoracic pressures must be at a minimum at:

A

end of expire

70
Q

2 primary causes of complications of CVC insertion

A
  1. pneumothorax

2. dysrrhthmias

71
Q

key indications for CVP monitoring?

A

hypo or hypervolemia monitoring

72
Q

what is ScvO2? and what is the normal value?

A

central venous catheter oxygen saturation

norm- 60-80%

73
Q

what percent of oxygenated blood bound to HgB returns back to heart?

A

65-75%

74
Q

what does ScvO2 reflect?

A

O2 supply and demand balance to brain and upper body

measured in central lines in superior vena cava

75
Q

what would it mean is ScvO2 = 58%

A

that O2 supply is not meeting O2 demand

76
Q

if a PT has a temp of 39.5 what would you anticipate the ScvO2 to be?

A

below 60 %

77
Q

if your PT has a SaO2 of 84% on 60% FiO2, what do you anticipate the ScvO2 to be?

A

below 60%

78
Q

increased preload on the heart can be describes as?

A

decreased force of diastole, leaving extra blood in the chamber

79
Q

what influencing factors might alter a PTs HR?

A
  • pain
  • anxious
  • temp
  • hypovolemia/ hypotension = altered baroreceptor input into vasomotor center in medulla = tachycardia
  • meds (BB)
80
Q

definition of preload:

influenced by?

A

vol of blood inthe ventricles at the end of diastole

by: venous return and total circulating vol

81
Q

what does a PT need if they have decreased vent compliance?

A

increased vent pressure and volume to support less stretch

82
Q

definition afterload

what is the primary determinant?

A

resistance or load against which the ventricles have to pump to eject blood and produce cardiac output

primary = tone or vessel diameter

mod 2 CC (3 decks)

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