hemodynamic monitoring seminar

Question 1

what is hemodynamics

Answer 1

forces that enable the heart to circulate blood through the cardiovascular system

Question 2

what is cardiac output

Answer 2

the amount blood your heart pumps out to your body per minute

Question 3

what is stroke volume

Answer 3

the amount of blood ejected from the ventricle with each cardiac cycle (L/beat)

Question 4

what is cardiac index

Answer 4

a measure that represents the hearts pumping ability relative to a person’s body size

Question 5

what is preload

Answer 5

the amount of stretching that occurs in the hearts ventricles when they fill with blood before they contract

Question 6

what is afterload

Answer 6

the amount of pressure the heart must exert to pumo blood out of the heart during ventricular contraction

Question 7

what is contractility

Answer 7

the hearts ability to contract and pump blood out of the heart

Question 8

types of hemodynamic monitoring systems

Answer 8

-CVP (central venous pressure)
-PAP (pulmonary artery pressure)
-PAWP(pulmonary artery wedge pressure)

Question 9

what do hemodynamic monitoring systems include

Answer 9

-pressure transducer
-pressure tubing
-monitoring
-pressure bag and flush device

Question 10

what is hemodynamic monitoring used to evalute?

Answer 10

-volume status (hyper/hypovolemia)
-cardiac function(SV and ejection fraction)
-integrity of the vascular system(shows immediate changes)
-physiologic response to therapies(meds)

Question 11

what are arterial lines used for

Answer 11

-continuous information about changes in blood pressure
-sampling of arterial blood

Question 12

insertion sites for arterial lines

Answer 12

-radial (most common)
-brachial
-femoral

Question 13

can you administer fluids via arterial line

Answer 13

NO

Question 14

what is mean arterial pressure

Answer 14

-the average pressure created during the cardiac cycle
-SBP + 2(DBP)/3

Question 15

how to identify good capnography?

Answer 15

-bumps will align with rests between beats in the cardiac monitoring
-may need to zero line or reposition is waveform is off

Question 16

what is a central venous catheter

Answer 16

inserted into a large vein to measure central venous pressure and draw mixed venous gases
-CAN BE USED FOR MED ADMIN

Question 17

where is central venous catheter placed

Answer 17

internal jugular
subclavian
femoral

Question 18

CVP capnography

Answer 18

-smaller peaks than art line d/t less pressure
-bumps align with beats on cardiac monitor

Question 19

what is a pulmonary artery catheter

Answer 19

-inserted into a large vein then threaded through the right atria and ventricle into a branch of a pulmonary artery

Question 20

what vein is a pulmonary artery catheter threaded through?

Answer 20

internal jugular
subclavian

Question 21

what are pulmonary artery catheters used for?

Answer 21

-hemodynamic measurements
-blood sampling
-infusion of IV fluids

Question 22

risk factors of a pulmonary artery catheter

Answer 22

-pneumothorax
-bleeding
-infection
-dissection

Question 23

indications for a pulmonary artery catheter

Answer 23

-critical illness (cant get a pressure any other way)
-post CABG surgery
-heart failure
-trauma/injury i.e.burns d/t inc need for fluids & no skin for art lines

Question 24

pulmonary artery catheter components

Answer 24

-syringe
-introducer with side port
-locking device
-markings
-connections to monitor
-catheter
-lumens (blue, white, yellow, red)
-thermistor
-balloon

Question 25

respiratory assessment with pulmonary artery catheter

Answer 25

should be clear
-crackles are an abnormal finding

Question 26

cardiac assessment with a pulmonary artery catheter

Answer 26

should be clear
-muffled indicates tamponade->dec contractility d/t fluid

Question 27

nursing considerations for line insertion

Answer 27

-ensure patient’s and family’s understanding of procedure
-assemble pressure monitoring system and purge air (MAINTAIN STERILITY OF CONNECTION)
-place patient in supine or trendelenberg
-administer sedation and pain medications
-level transducer with phlebostatic axis and zero the system
-obtain intial reading

Question 28

where is the phlebostatic axis

Answer 28

-level with right atrium then purge air
-4th intercoastal space->mid axilla->along nipple line

Question 29

nursing considerations post procedure

Answer 29

-obtain chest xray to confirm catheter placement for PAWP
-continually monitor respiratory and cardiac status
-maintain line patency and integrity
-obtain reading from hemodynamic catheter
-assess for complications (I.E. Infection/sepsis and embolism)