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hemodynamic monitors and equipment Flashcards

1
Q

during oscillometric method of BP measurement, MAP is measured when

A

amplitude of oscillations are greatest (most accurate data obtained form oscillometric method)

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2
Q

ideal bladder length and width of BP cuff

A

length: 80% of extremity circumference
ideal width: 40% of extremity circumference

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3
Q

is the pressure utilized to occlude artery different when cuff is too small or large?

A

yes, pressure utilized to occlude artery is less when cuff is too large and
more when cuff is too small

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4
Q

as the pulse moves from the aortic root to the periphery, what happens to SBP DBP and PP

A

SBP increases
DBP decreases
PP widens

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5
Q

describe SBP DBP and PP at aortic root

A

SBP is lowest
DBP is highest
PP is narrowest

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6
Q

describe SBP DBP and PP at radial artery

A

SBP is higher
DBP is lower
PP is wider

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7
Q

describe SBP DBP and PP at dorsalis pedis

A

SBP is highest
DBP is lowest
PP is widest

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8
Q

what happens to the dichrotic notch as you move further away from the heart

A

it moves further from the systolic peak

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9
Q

for every 10cm change, the BP changes

A

7.4mmHg

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10
Q

for every inch change, the BP changes

A

2mmHg

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11
Q

arterial wave form analysis:
SBP
DBP
PP
contractility
SV
dichrotic north

A

SBP: peak of wave form
DBP: trough of wave form
PP: peak value minus trough value
contractility: up stroke
SV: area under curve
dichrotic notch: closure of aortic valve

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12
Q

a line transducer should be at the level of the

A

right atrium

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13
Q

if you want to monitor CPP, where do you put aline transducer

A

external auditory meatus (corresponds to circle of willis)

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14
Q

what happens when a line is under damped

A

baseline re established after several oscillations
SBP over estimated, DBP under estimated, MAP is accurate
causes include stiff tubing (catheter) and whip (artifact)

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15
Q

what happens when a line is over damped and causes (5)

A

baseline is established with no oscillations
SBP under estimated, DBP over estimated, MAP accurate
causes: air bubble in pressure tubing, clot in catheter, low flush bag pressure, kinks, loose connection

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16
Q

tip of CVP catheter should rest (and normal value)

A

just above junction of vena cava and RA
1-10mmHg

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17
Q

how far is pulmonic artery (where PA cath is placed) in relation to vena cava junction?

A

25-35cm

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18
Q

how far to insert CVC to vena cava/right atrial junction?
subclavian (either side)
RIJ, LIJ
R/L median basillic
femoral

A
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19
Q

how much further to insert catheter from vena cava/right atrial junction to get to
right atrium
right ventricle
PAOP position
pulmonary artery

A
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20
Q

if you encounter resistance when pulling PA cath back, what is probably happening

A

knotted in chordae tendinae (get CXR)

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21
Q

complication of CVC’s while obtaining venous access include

A

arterial puncture
pneumothorax
air embolism
neuropathy
catheter knot

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22
Q

catheter resistance while inserting CVC complications include

A

bacterial colonization on catheter
bacterial colonization of heart or pulmonary artery
myocardial or valvular injury
sepsis
thrombus formation
thrombophlebitis
misinterpretation of data

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23
Q

complications that can occur when floating PA catheter include (4)

A

pulmonary artery rupture
R bundle branch block
complete heart block (if pre existing LBBB)
dysthrythmias

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24
Q

obtaining access via left IJ has added risk of

A

puncturing thoracic duct. can cause chylothorax

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25
Q

do you float a PAC in a patient with LBBB

A

LOL, no. you can cause a RBBB when you get in the right atrium then
ded

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26
Q

classic presentation of pulmonary artery rupture

A

hemoptysis

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27
Q

ID the parts of this right atrial wave form and the correlating mechanical events of the heart

A
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28
Q

ID how the CVP wave form correlates with electrical events of the heart

A
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29
Q

A wave mechanical event and electrical event

A

right atrial contraction
just after P wave (atrial depol)

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30
Q

C wave mechanical event and electrical event

A

right ventricular contraction (bulging of tricuspid into RA)
just after QRS complex (ventricular depol)

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31
Q

V wave mechanical event and electrical event

A

passive filling of RA
just after T wave begins (ventricular repol)

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32
Q

X descent mechanical event and electrical event

A

RA relaxation
ST segment

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33
Q

Y descent mechanical event and electrical event

A

RA empties through open tricuspid valve
after T wave ends

34
Q

how does PEEP affect CVP

A

PEEP increases CVP because it increases PVR

35
Q

where (and when) CVP should be measured

A

at phlebostatic axis. (4th ICS at mid anteroposterior level)
measured at end expiration (not affected by intrathoracic pressure, reading in relation to solely atmospheric pressure)

36
Q

normal CVP value

A

1-10mmHg

37
Q

CVP is a function of (3)

A

intravascular volume
venous tone
RV compliance

38
Q

factors that increase CVP

A

transducer below phlebostatic axis
hypervolemia
RV failure
tricuspid stenosis or regurg
pulmonic stenosis
PEEP
VSD
constrictive pericarditis
pericardial tamponade

39
Q

factors that decrease CVP

A

transducer above phlebostatic axis
hypovolemia

40
Q

explain why this would occur

A

loss of a wave: afib, v pacing if underlying rhythm is asystole

41
Q

explain why this would occur

A

atrium contracting and emptying against high resistance –> large a wave
tricuspid stenosis
diastolic dysfunction
MI
chronic lung disease leading to RV hypertrophy
AV dissociation
junctional rhythm
asynchronous v pacing
PVC’s

42
Q

explain why this would occur

A

increased volume and pressure in RA manifests as increased V waves ( c and v waves may blend into each other)
tricuspid regurg
acute increase in intravascular volume
RV papillary muscle ischemia

43
Q

which findings are observed when tip of PAC enters this area?

A

dichrotic notch, increased DBP

44
Q

PA waveform: RAP

A

same as CVP (so nothing new to add)

45
Q

PA waveform: RVP

A

systolic pressure increases
DBP = CVP

46
Q

PA waveform: PAP

A

SBP remains same
DBP rises
dichrotic notch formed during pulmonic valve closure during diastole

47
Q

PA waveform: PAOP

A

waveform is akin to CVP of left heart
a wave caused by left atrial systole
c wave is caused by mitral valve elevation into LA during LV systole (is-volumetric contraction)
v wave is caused by passive left atrial filling

48
Q

which lung zone should the tip of the PAC be placed?

A

west zone 3 (provides most accurate estimation of LVEDP)

49
Q

west zone review (1-3)

A
50
Q

how can you tell the tip of the PAC is in west zone 3

A

PAOP > pulmonary artery end diastolic pressure
nonphaseic PAOP tracing
inability to aspirate blood from distal port when balloon is in wedged position

51
Q

when does PAOP over estimate LVEDV/P?
under estimate?

A

over estimate: PEEP and diastolic dysfunction, impaired LV compliance (ishchemia), MV disease (stenosis or regurg), left to right cardiac shunt, tachycardia, PPV, COPD, pHTN, non west zone placement of PAC

under estimate: aortic insufficiency

52
Q

which situation under estimates CO obtained by thermodilution method

A

high injectate volume

53
Q

explain thermodilution method

A

injection of 5% dextrose or .9% NaCl of known quantity and temp is bolused through proximal port on PAC
each injection should occur during the same phase of the respiratory cycle and be completed in <4 seconds
usually average 3 separate injections

area under curve (AUC) is inversely proportional to CO
if CO is high, injectate rapidly goes towards AUC and waveform is smaller. takes more time for low CO to travel past tip so AUC is larger

54
Q

ways thermodilution method under estimates CO

A

injectate volume too high
injectate solution too cold

55
Q

ways thermodilution method over estimates CO

A

injectate volume too low
injectate solution too hot
partially wedged PAC
thrombus on tip of PAC

56
Q

ways thermodilution method is unable to estimate CO (2)

A

intracardiac shunt
tricuspid regurg

57
Q

drawback to continuous CO (CCO)

A

its an average of the CO for 3-6m so is not helpful in unstable patient

58
Q

mixed venous O2 sat is a function of 4 variables (and equation/normal value)

A
  1. Q= CO (L/min)
  2. VO2 = O2 consumption (mL O2/min)
  3. Hgb = (g/dL)
  4. SaO2 = loading of HGB in arterial blood (%)

normal = 65-75%

59
Q

when can mixed venous O2 become an indirect monitor of CO

A

when Hgb, SaO2, VO2 are all held constant

60
Q

factors that decrease SvO2

A

increased O2 consumption (stress, pain, thyroid storm, shivering, fever)
decreased O2 delivery (decreased PaO2, decreased HGB, decreased CO)

61
Q

factors that increase SvO2

A

decreased O2 consumption (hypothermia, cyanide toxicity), increased O2 delivery (increased PaO2, HGB, CO)

62
Q

sepsis and SvO2

A

causes high output CO state. even though it causes end organ hypoxia, O2 essentially bypasses organs and causes increase in SvO2

63
Q

SvO2 and cyanide poisoning/Na NTP

A

impairs O2 uptake by tissues, increases SvO2

64
Q

SvO2 and left to right shunt

A

oxygenated blood travels from left to right heart and is added to p.venous blood

65
Q

explain pulse contour analysis

A

provides measure of preload responsiveness as a function of how stroke volume changes during the respiratory cycle (assuming PPV)
(aka changes in intrathoracic pressure during PPV can affect SV)

66
Q

preload responsiveness can be assumed when 200-250mL bolus increases SV by

A

10%

67
Q

limitations to pulse contour analysis include (6)

A

spontaneous ventilation
small Vt
PEEP
open chest
RV dysfunction
dysrhythmias

68
Q

tip of TEE probe should be positioned at

A

~35cm from incisors (T5/T6) or at third intercostal junction

69
Q

define peak velocity r/t TEE

A

index of contractility

70
Q

define flow time r/t TEE

A

timing of flow from LV during systole

71
Q

define flow time corrected (FTC) r/t TEE

A

flow time indexed to a HR of 60BPM

72
Q

define mean acceleration r/t TEE

A

average speed of up stroke of wave form (cm/sec)

73
Q

define cycle time r/t TEE

A

time of one cardiac cycle

74
Q

define stroke distance r/t TEE

A

how far SV is pumped along aorta per beat

75
Q

TEE waveform decreased versus increased preload

A
76
Q

TEE waveform decreased versus increrased afterload

A
77
Q

TEE waveform deceased versus increased inotropy

A
78
Q

limitations r/t esophageal doppler

A

aortic stenosis
aortic insufficiency
disease of thoracic aorta
aortic cross clamping
after CPB
pregnancy

79
Q

normal PAOP value

A

5-15mmhg

80
Q

SvO2= (equation)

A

normal 65-75%

81
Q
A

change via a vasodilator (ex clevidipine)

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