Hemodynamic Monitoring Flashcards
What is HEMODYNAMIC MONITORING?
Hemodynamic monitoring assesses CARDIAC FUNCTION via:
- fluid balance + fluid status
- effects of fluids
- effects of medications on cardiac output
- how well is the perfusion
What is used for HEMODYNAMIC MONITORING?
internal and/or invasive catheters
Are the internal/invasive catheters the only way to monitor perfusion?
NO; a good, basic perfusion assessment can actually help catch decreased perfusion early on. It is important to assess frequently and include comparison of previous assessments to determine if if decreased perfusion is present
What is included in a perfusion assessment?
- skin color (appropriate for race/ethnic)
- nail beds (cap refill <3 sec + color)
- skin temp (warm vs cool + why)
- peripheral pulses (decompensating can quickly lead to decreased peripheral pulses; monitor closely + compare to previous)
- bowel sounds (absent - HYPOactive?
- HTN (trying to compensate for decreased perfusion)
- RR (increased to try and get more oxygen in for perfusion)
- general weakness + fatigue (lack of oxygen)
- change in mental status (lack of oxygen)
- stroke S/S (this can mean there is a blockage which decreases perfusion)
- activity tolerance change (decreased tolerance can mean decreased perfusion)
- pain present? (chest pain (blockage), limb pain (blockage), etc. )
- heart sounds (any extra? + why)
What is NIBP?
Non-Invasive Blood Pressure = normal way we obtain blood pressures as nurses
What is arterial blood pressure (line)
A line that is placed after: surgery, graft, MI, etc. that provides the ability to have the most accurate B/P.
Do nurses put in arterial B/P line?
NO! BUT nurses do have to manage these lines and read the data put out by these lines
Is this line just hanging freely?
NO! This line can be sutured, but isn’t always; however it MUST be secured and really needs a biopatch applied to reduce risk of infection.
What goes into managing these lines?
Frequent assessments of these lines to ensure there is no:
- blockages/occlusions
- bleeding
- movement of line
What data does an arterial line provide?
Systolic B/P
Diastolic B/P
MAP
What does the arterial pressure wave look like?
EKG strip! the arterial pressure wave line should mimic movements like the EKG;
QRS should reflect heartbeat
What is important to remember about alarms for arterial pressure monitoring?
Alarms should be set accurately to ensure that we are notified if the pressure is no longer within desired limits! Frequently these are used on patients that need medications titrated and this allows for accurate and precise titration.
What are some common complications of Arterial Lines?
- bleeding at site
- movement of line
- clot formation
- nerve damage to whatever extremity line is in
What is the Allens Test?
Allens test confirms the quality of perfusion or circulation to the extremity before placement occurs
How is the Allens Test performed?
occlude ulnar & radial arteries at same time
Have patient pump fist few times
Should be blanchable
release pressure of artery and perfusion should reoccur within 6 seconds
= OK to proceed with arterial pressure line
What is CVP?
Central Venous Pressure - CVP; measures preload in RT ventricle + looks at volume status
Who even needs a CVP?
- MI
- heart failure
- acute renal failure
- burn victums
- septic
- HYPOvolemic shock
- cardiogenic shock
Where is a CVP placed?
Central venous catheter that is placed into the SUBCLAVIAN VEIN + tip goes into the RT atria
Why does it make more sense to have a CVP with a multi-lumen line?
Multi-lumen allows to administration of medications, blood, fluids etc.
What is a normal CVP?
2-8
What can cause HIGH CVP?
fluid volume overload (RT sided heart failure OR RT ventricle failure); LOTS OF PRESSURE
What can cause LOW CVP?
HYPOvolemia; low fluid; too dry (pt needs fluids); TOO LITTLE PRESSURE
How is the patient positioned to zero out the stopcock?
lay patient flat on back
draw line down 4th intercostal space
draw line down armpit
**this is where transducer will be level with atria
Why does it matter where the transducer is?
Too high = FALSE LOW read
Too low = FALSE HIGH read
