Hemodynamic monitoring/CVAD Flashcards
What is a dicrotic notch?
where valve closes at end of QRS wave
What is the goal of hemodynamics?
Maintain a MAP >65
what are the components of hemodynamic monitoring?
- -Invasive catheter (threaded into artery/vein)
- -Swan Ganz Catheter (PA)
- -stop cock
- -continuous flush
- -infusion pressure bag
What is an infusion pressure bag used for?
It prevents clots from forming in catheter
what can increase CO?
- -Early septic shock
- -Hypervolemia
- -Hyperthermia
What can decrease CO?
- -MI
- -Any kind of shock (except early septic shock)
what is the treatment for decreased CO?
- -bolus (give volume)
- -Inotropic drugs (digoxin)
What is normal Central venous pressure (CVP)?
2-6 mmHg
What does a CVP catheter allow for?
- -rapid infusion for hypertonic solution
- -meds that can damage veins
- -reduce sticks for blood draw
What position does the transducer need to be in?
Phlebostatic position
What can cause an elevated CVP?
- -right HF
- -Tension pneumo, pulmonary HTN (puts strain on right side of heart)
- -Pericardial tamponade
How would elevated CVP be treated?
- -treat underlying
- -Inotropes
- -Vasodilators
What are signs of a decreased CVP?
- -hypovolemia
- -Peripheral vasodilation
How would a decreased CVP be treated?
- -Bolus (hypovolemia)
- -Vasopressor (peripheral dilation)
What artery is the catheter usually inserted for arterial pressure monitoring/
radial
There is a pressurized bag that is attached to a fluid filled system when using arterial pressure monitoring, what should the bag be pressurized at?
300 mmHg (green zone ideal)
What should the pressure be at for central VENOUS monitoring?
150 mmHg
Pulmonary arterial monitoring is also called?
Swan Ganz Catheter
What does the pulmonary artery monitoring do?
evaluates LV and overall cardiac fx.
What locations would the lumens be in pulmonary arterial monitoring?
–multiple lumens measure pressure in RA, PA, and LV
What is normal SYSTOLIC PA pressure?
15-25 mmHg
What is a normal DIASTOLIC PA pressure?
8-15 mmHg
What is the mean PA pressure?
25 mmHg
What is the normal PA pressure range?
15/8 - 25/15
What would an increased PA pressure indicate?
- -COPD/Emphysema
- -PE
- -LV failure
How would increased PA pressure be treated?
- -inotropes
- -vasodilators
- -diuresis
What is pulmonary capillary wedge pressure?
Blocks pressure from behind balloon
What does pulmonary capillary wedge pressure measure?
the pressure ahead of the catheter (LV pressure)
What can PCWP be used for?
- -Cardiogenic shock
- -Hypoxia
- -ARDS
What is the treatment for elevated Pulmonary capillary pressure?
- -Inotropes
- -Vasodilators
- -Diuresis
What does systemic vascular resistance measure?
–measures afterload
What is the treatment for increased SVR?
Vasodilators (decrease afterload)
What can cause a decreased SVR?
Distributive shock
What is the treatment for a decreased SVR?
- -bolus
- -vasopressors (tightens the tank)
what is a central venous access device (CVAD)?
Catheter that is inserted into high flow, large blood vessel
What is an ideal area for a CVAD to be inserted?
- -Superior vena cava (SVC)
- -right atriocaval junction
Before a CVAD can be used what must be done to determine placement?
x-ray
What can a Peripherally inserted central catheter (PICC) line be used for?
- -small veins
- -chemo
- -antibiotics
- -TPN
What are some risks for having a CVAD (PICC)?
- -Phlebitis
- -Vasospasm
- -Arrythmias
- -excessive bleeding
- -N/T in arms/hands
- -chest pain
Where is a short term,non-tunneled central catheter inserted?
–Subclavian vein/jugular
What does the catheter inserted into the subclavian vein/jugular have to have?
–clamps (prevents air into central circulation)
What must the nurse remember about clamps on the central catheter?
- -clamp before attaching syringe
- -close clamps before removing syringe
an implanted venous access device can only be accessed with….
Huber needle (non-coring)
What are some reasons to use a CVAD?
- -TPN
- -chemo
- -frequent blood draws
- -emergency access (rapid infusion fluids)
- -Monitor CVP (ICU)
- -Poor peripheral venous access
- -protects small veins from damage
- -patient preference (cant handle being stuck so many times)
What are some advantages to using CVAD?
- -reliable long term access
- -used for multiple blood samples
- -blood products, meds, TPN, fluids
- -removes need for constant sticks
What are some disadvantages using a CVAD?
- -Risk infection
- -Risk thrombus (make sure to flush)
- -pneumothorax during insertion
- -affect body image
- -can be traumatic to patient
what fluid should be used with CVAD to ensure patency?
Heparin/NS flush
What are three key principles in CVAD management?
- -Prevent infection
- -Maintain patency
- -Prevent damage
What vein should be avoided to prevent CLABSI?
femoral vein
To provide maximum barrier precautions, what protective equipment should be worn with insertion of CVAD?
- -cap
- -mask
- -sterile gown/gloves
- -cover pt. head to toe with sterile drape
- -enforce central line CHECKLIST
What nutrients does Parenteral nutrition contain?
- -proteins
- -carbs
- -fats
- -electrolytes
- -vitamins, minerals
- -sterile water
How can parenteral nutrition be delivered?
central line/peripherally (depends on hypertonicity)
What should a nurse monitor if a patient is receiving parenteral nutrition?
–blood sugar levels (monitor for hyper/hypoglycemia)
What are some potential complications with CVAD’s?
- -PNEUMOTHORAX
- -clotted/displaced catheter
- -SEPSIS
- -hyperglycemia
- -rebound hypoglycemia
- -fluid overload
When giving fluids with CVAD’s, what should always be used to administer it?
infusion pump
With CVAD’s flow rate should not be increased or decreased_____.
If fluid runs out the nurse should hang _____ _____ solution.
- -rapidly
- -10% dextrose
Why do we want to hang 10% dextrose solution if TPN runs out?
–b/c TPN is high in sugar and can bottom them out of they go from TPN to nothing
Proper placement of a CVAD will prevent what complications?
- -Catheter migration
- -Phlebitis
- -Damaged catheter
What are some examples of vasoactive meds?
- -epinephrine
- -norepinephrine
- -dopamine
- -vasopressin
How often should VS be checked when giving vasoactive meds?
every 15 min.
where should vasoactive meds be given and why?
–central line to prevent damage to tissue
