Hemodynamic Monitoring Flashcards
What are the components of hemodynamic monitoring?
Disposable flush system
Pressure bag
Transducer
Amplifier or monitor
What is the pressure bag maintained at?
300 mmHg
Where should the transducer be positioned?
At the level of the atrium (phlebostatic axis)
Where is the phlebostatis axis located?
4th intercostal space, midaxillary line
Location of R atrium
ALWAYS use a leveling device, do not “eyeball” the axis
Steps to zero monitoring
- After leveling transducer, open transducer to air
2. Activate the zero function on bedside monitor
Complications of monitoring
Pneumothorax
Infection
Air embolism
What is the most common & preventable complication?
Catheter-related bloodstream infection
Where is CVP obtained from?
- Pressure in vena cava R atrium
- Also reflects filling pressure of R ventricle (preload)
What is a normal CVP?
2-6
What does it mean if CVP is >6?
Elevated R ventricle preload
Common causes of high CVP
Hypervolemia - R sided HF - excessive fluid in body
Causes of low CVP
Hypovolemia - dehydration, excessive blood loss, vomiting/diarrhea, over-diuresis
What is the preferred insertion site for CVP?
Subclavian vein
What is PAP used to monitor?
- L ventricle function
- Etiology of shock
- Evaluating pt’s response to fluids & meds
Where is distal lumen of PAP?
Port opens into pulmonary artery — used to measure pulmonary artery pressure
Where is the proximal lumen of PAP?
Port opens into R atrium — used to admin IVF, meds, monitor R atrial pressure
What does pulmonary wedge pressure (PAWP) reflect?
Left ventricular end diastolic pressure (preload)
What is normal PAWP?
8-12
Preferred insertion site of PAP
Subclavian vein
Complications of PAP
Pulmonary artery rupture Pulmonary thromboembolism Pulmonary infarction Catheter kinking Dysrhythmias Air embolism
What’s intra-arterial pressure monitoring used for?
- Obtain direct and continuous BP measurements
- When arterial blood gas measurements and blood samples are needed frequently
Usual site for intra-arterial pressure monitoring?
Radial artery
Pt’s @ risk for impeded perfusion S/T intra-arterial monitoring
DM, PVD, hypotension, receiving vasopressors, previous SX in the area
Performing Allen test
- Hand is elevated and the pt is asked to make a fist for 30 secs
- Nurse compressed radial and ulnar arteries simultaneously, causing hand to blanch
- After patient opens fist, nurse releases pressure on ulnar artery, still compressing radial artery
- If blood flow is restored (hand turns pink) w/in 6 secs, circulation to the hand is adequate enough to tolerate placement of radial catheter
Complications of intra-arterial pressure monitoring
Local obstruction w/distal ischemia External hemorrhage Massive ecchymosis Dissection Air embolism Blood loss Pain Arteriospasm Infection
