Hemodynamic Monitoring

Question 1

What are the components of hemodynamic monitoring?

Answer 1

Disposable flush system
Pressure bag
Transducer
Amplifier or monitor

Question 2

What is the pressure bag maintained at?

Answer 2

300 mmHg

Question 3

Where should the transducer be positioned?

Answer 3

At the level of the atrium (phlebostatic axis)

Question 4

Where is the phlebostatis axis located?

Answer 4

4th intercostal space, midaxillary line
Location of R atrium
ALWAYS use a leveling device, do not “eyeball” the axis

Question 5

Steps to zero monitoring

Answer 5

1. After leveling transducer, open transducer to air

2. Activate the zero function on bedside monitor

Question 6

Complications of monitoring

Answer 6

Pneumothorax
Infection
Air embolism

Question 7

What is the most common & preventable complication?

Answer 7

Catheter-related bloodstream infection

Question 8

Where is CVP obtained from?

Answer 8

• Pressure in vena cava R atrium

- Also reflects filling pressure of R ventricle (preload)

Question 9

What is a normal CVP?

Answer 9

2-6

Question 10

What does it mean if CVP is >6?

Answer 10

Elevated R ventricle preload

Question 11

Common causes of high CVP

Answer 11

Hypervolemia - R sided HF - excessive fluid in body

Question 12

Causes of low CVP

Answer 12

Hypovolemia - dehydration, excessive blood loss, vomiting/diarrhea, over-diuresis

Question 13

What is the preferred insertion site for CVP?

Answer 13

Subclavian vein

Question 14

What is PAP used to monitor?

Answer 14

• L ventricle function
• Etiology of shock
• Evaluating pt’s response to fluids & meds

Question 15

Where is distal lumen of PAP?

Answer 15

Port opens into pulmonary artery — used to measure pulmonary artery pressure

Question 16

Where is the proximal lumen of PAP?

Answer 16

Port opens into R atrium — used to admin IVF, meds, monitor R atrial pressure

Question 17

What does pulmonary wedge pressure (PAWP) reflect?

Answer 17

Left ventricular end diastolic pressure (preload)

Question 18

What is normal PAWP?

Answer 18

8-12

Question 19

Preferred insertion site of PAP

Answer 19

Subclavian vein

Question 20

Complications of PAP

Answer 20

Pulmonary artery rupture 
Pulmonary thromboembolism 
Pulmonary infarction
Catheter kinking 
Dysrhythmias 
Air embolism

Question 21

What’s intra-arterial pressure monitoring used for?

Answer 21

• Obtain direct and continuous BP measurements

- When arterial blood gas measurements and blood samples are needed frequently

Question 22

Usual site for intra-arterial pressure monitoring?

Answer 22

Radial artery

Question 23

Pt’s @ risk for impeded perfusion S/T intra-arterial monitoring

Answer 23

DM, PVD, hypotension, receiving vasopressors, previous SX in the area

Question 24

Performing Allen test

Answer 24

1. Hand is elevated and the pt is asked to make a fist for 30 secs
2. Nurse compressed radial and ulnar arteries simultaneously, causing hand to blanch
3. After patient opens fist, nurse releases pressure on ulnar artery, still compressing radial artery
4. 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

Question 25

Complications of intra-arterial pressure monitoring

Answer 25

Local obstruction w/distal ischemia 
External hemorrhage
Massive ecchymosis 
Dissection 
Air embolism
Blood loss
Pain
Arteriospasm
Infection