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NUR 221 > Hemodynamic monitoring/CVAD > Flashcards

Hemodynamic monitoring/CVAD Flashcards

1
Q

What is a dicrotic notch?

A

where valve closes at end of QRS wave

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2
Q

What is the goal of hemodynamics?

A

Maintain a MAP >65

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3
Q

what are the components of hemodynamic monitoring?

A
  • -Invasive catheter (threaded into artery/vein)
  • -Swan Ganz Catheter (PA)
  • -stop cock
  • -continuous flush
  • -infusion pressure bag
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4
Q

What is an infusion pressure bag used for?

A

It prevents clots from forming in catheter

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5
Q

what can increase CO?

A
  • -Early septic shock
  • -Hypervolemia
  • -Hyperthermia
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6
Q

What can decrease CO?

A
  • -MI

- -Any kind of shock (except early septic shock)

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7
Q

what is the treatment for decreased CO?

A
  • -bolus (give volume)

- -Inotropic drugs (digoxin)

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8
Q

What is normal Central venous pressure (CVP)?

A

2-6 mmHg

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9
Q

What does a CVP catheter allow for?

A
  • -rapid infusion for hypertonic solution
  • -meds that can damage veins
  • -reduce sticks for blood draw
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10
Q

What position does the transducer need to be in?

A

Phlebostatic position

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11
Q

What can cause an elevated CVP?

A
  • -right HF
  • -Tension pneumo, pulmonary HTN (puts strain on right side of heart)
  • -Pericardial tamponade
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12
Q

How would elevated CVP be treated?

A
  • -treat underlying
  • -Inotropes
  • -Vasodilators
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13
Q

What are signs of a decreased CVP?

A
  • -hypovolemia

- -Peripheral vasodilation

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14
Q

How would a decreased CVP be treated?

A
  • -Bolus (hypovolemia)

- -Vasopressor (peripheral dilation)

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15
Q

What artery is the catheter usually inserted for arterial pressure monitoring/

A

radial

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16
Q

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?

A

300 mmHg (green zone ideal)

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17
Q

What should the pressure be at for central VENOUS monitoring?

A

150 mmHg

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18
Q

Pulmonary arterial monitoring is also called?

A

Swan Ganz Catheter

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19
Q

What does the pulmonary artery monitoring do?

A

evaluates LV and overall cardiac fx.

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20
Q

What locations would the lumens be in pulmonary arterial monitoring?

A

–multiple lumens measure pressure in RA, PA, and LV

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21
Q

What is normal SYSTOLIC PA pressure?

A

15-25 mmHg

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22
Q

What is a normal DIASTOLIC PA pressure?

A

8-15 mmHg

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23
Q

What is the mean PA pressure?

A

25 mmHg

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24
Q

What is the normal PA pressure range?

A

15/8 - 25/15

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25
Q

What would an increased PA pressure indicate?

A
  • -COPD/Emphysema
  • -PE
  • -LV failure
26
Q

How would increased PA pressure be treated?

A
  • -inotropes
  • -vasodilators
  • -diuresis
27
Q

What is pulmonary capillary wedge pressure?

A

Blocks pressure from behind balloon

28
Q

What does pulmonary capillary wedge pressure measure?

A

the pressure ahead of the catheter (LV pressure)

29
Q

What can PCWP be used for?

A
  • -Cardiogenic shock
  • -Hypoxia
  • -ARDS
30
Q

What is the treatment for elevated Pulmonary capillary pressure?

A
  • -Inotropes
  • -Vasodilators
  • -Diuresis
31
Q

What does systemic vascular resistance measure?

A

–measures afterload

32
Q

What is the treatment for increased SVR?

A

Vasodilators (decrease afterload)

33
Q

What can cause a decreased SVR?

A

Distributive shock

34
Q

What is the treatment for a decreased SVR?

A
  • -bolus

- -vasopressors (tightens the tank)

35
Q

what is a central venous access device (CVAD)?

A

Catheter that is inserted into high flow, large blood vessel

36
Q

What is an ideal area for a CVAD to be inserted?

A
  • -Superior vena cava (SVC)

- -right atriocaval junction

37
Q

Before a CVAD can be used what must be done to determine placement?

A

x-ray

38
Q

What can a Peripherally inserted central catheter (PICC) line be used for?

A
  • -small veins
  • -chemo
  • -antibiotics
  • -TPN
39
Q

What are some risks for having a CVAD (PICC)?

A
  • -Phlebitis
  • -Vasospasm
  • -Arrythmias
  • -excessive bleeding
  • -N/T in arms/hands
  • -chest pain
40
Q

Where is a short term,non-tunneled central catheter inserted?

A

–Subclavian vein/jugular

41
Q

What does the catheter inserted into the subclavian vein/jugular have to have?

A

–clamps (prevents air into central circulation)

42
Q

What must the nurse remember about clamps on the central catheter?

A
  • -clamp before attaching syringe

- -close clamps before removing syringe

43
Q

an implanted venous access device can only be accessed with….

A

Huber needle (non-coring)

44
Q

What are some reasons to use a CVAD?

A
  • -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)
45
Q

What are some advantages to using CVAD?

A
  • -reliable long term access
  • -used for multiple blood samples
  • -blood products, meds, TPN, fluids
  • -removes need for constant sticks
46
Q

What are some disadvantages using a CVAD?

A
  • -Risk infection
  • -Risk thrombus (make sure to flush)
  • -pneumothorax during insertion
  • -affect body image
  • -can be traumatic to patient
47
Q

what fluid should be used with CVAD to ensure patency?

A

Heparin/NS flush

48
Q

What are three key principles in CVAD management?

A
  • -Prevent infection
  • -Maintain patency
  • -Prevent damage
49
Q

What vein should be avoided to prevent CLABSI?

A

femoral vein

50
Q

To provide maximum barrier precautions, what protective equipment should be worn with insertion of CVAD?

A
  • -cap
  • -mask
  • -sterile gown/gloves
  • -cover pt. head to toe with sterile drape
  • -enforce central line CHECKLIST
51
Q

What nutrients does Parenteral nutrition contain?

A
  • -proteins
  • -carbs
  • -fats
  • -electrolytes
  • -vitamins, minerals
  • -sterile water
52
Q

How can parenteral nutrition be delivered?

A

central line/peripherally (depends on hypertonicity)

53
Q

What should a nurse monitor if a patient is receiving parenteral nutrition?

A

–blood sugar levels (monitor for hyper/hypoglycemia)

54
Q

What are some potential complications with CVAD’s?

A
  • -PNEUMOTHORAX
  • -clotted/displaced catheter
  • -SEPSIS
  • -hyperglycemia
  • -rebound hypoglycemia
  • -fluid overload
55
Q

When giving fluids with CVAD’s, what should always be used to administer it?

A

infusion pump

56
Q

With CVAD’s flow rate should not be increased or decreased_____.
If fluid runs out the nurse should hang _____ _____ solution.

A
  • -rapidly

- -10% dextrose

57
Q

Why do we want to hang 10% dextrose solution if TPN runs out?

A

–b/c TPN is high in sugar and can bottom them out of they go from TPN to nothing

58
Q

Proper placement of a CVAD will prevent what complications?

A
  • -Catheter migration
  • -Phlebitis
  • -Damaged catheter
59
Q

What are some examples of vasoactive meds?

A
  • -epinephrine
  • -norepinephrine
  • -dopamine
  • -vasopressin
60
Q

How often should VS be checked when giving vasoactive meds?

A

every 15 min.

61
Q

where should vasoactive meds be given and why?

A

–central line to prevent damage to tissue

NUR 221 (9 decks)

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