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Apex Review > Hemodynamic monitors & equipment > Flashcards

Hemodynamic monitors & equipment Flashcards

1
Q

A blood pressure cuff that is too large:
a. falsely increases the blood pressure measurement
b. requires less pressure to occlude the artery
c. increases the risk of radial neuropathy
d. has a bladder width of less than 40 percent of the circumference of the extremity

A

b. requires less pressure to occlude the artery

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2
Q

A cuff that is too small ___________ SBP

A

overestimates

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3
Q

A cuff that is too large ______________ SBP

A

underestimates

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4
Q

The auscultation method of blood pressure monitoring relies on

A

the Korotkoff sounds

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5
Q

SBP is measured at

A

the first sound

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6
Q

DBP is measured when

A

the last sound disappears

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7
Q

The oscillatory method is

A

as the cuff pressure is released, the monitor measures the pressure fluctuations that occur in response to arterial pulsations

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8
Q

Complications of the oscillatory method include

A

pain, neuropathy, bruising, measurement errors, compartment syndrome, petechiae, interference with IV medications if IV is distal to the cuff, and limb ischemia

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9
Q

What factors affect the accuracy of the oscillatory method?

A

bladder size
site of the BP measurement
arm positioning

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10
Q

The ideal length of the bladder is

A

80% of the extremity circumference

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11
Q

The ideal width of the bladder is

A

40% of the extremity circumference

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12
Q

For every 10 cm change, the BP changes by

A

7.4 mmHg

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13
Q

For every 1 inch change, the BP changes by

A

2 mmHg

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14
Q

At the aortic root, the ______ is the lowest, ______ is the highest, and ______ is the narrowest

A

SBP; DBP, PP

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15
Q

At the dorsalis pedis artery, the ______ is the highest, the __________ is the lowest, and the ______ is the widest

A

SBP, DBP, PP

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16
Q

Do not place the BP over

A

a PICC line, bone fracture, or a limb with an AV fistula

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17
Q

With the oscillometric method, SBP is measured when

A

oscillations first appear

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18
Q

With the oscillometric method, MAP is measured when

A

the amplitude of the oscillations is greatest

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19
Q

With the oscillometric method, DBP is measured at

A

the minimum pressure where oscillations can still be registered

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20
Q

The oscillometric method requires pulsatile flow so a NIBP cuff won’t function in the

A

patient on cardiopulmonary bypass or with a left ventricular assist device- these patients require an arterial line

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21
Q

Etiologies of an over-dampened arterial line waveform include:
a. air bubbles in the pressure tubing
b. low flush bag pressure
c. improper zero location
d. loss of dicrotic notch

A

a. air bubbles in the pressure tubing
b. low flush bag pressure

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22
Q

Invasive blood pressure monitors measure BP at the level of _____________________ not __________________

A

the transducer; not the site of insertion

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23
Q

What effect does an under-damped arterial BP system have on SBP, DBP, and MAP?

A

SBP: overestimated
DBP: underestimated
MAP: accurate

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24
Q

What effect does an over-damped system have on SBP, DBP, and MAP?

A

SBP: underestimated
DBP: overestimated
MAP: accurate

25
Q

What correlates to the peak of the arterial waveform?

A

systolic BP

26
Q

What correlates to the trough of the waveform?

A

diastolic BP

27
Q

What correlates to the peak value minus trough value of the arterial waveform?

A

pulse pressure

28
Q

What correlates to the upstroke of the arterial waveform?

A

contractility

29
Q

What correlates to the area under the curve of the arterial waveform?

A

stroke volume

30
Q

What correlates to the dicrotic notch of the arterial waveform?

A

closure of aortic valve

31
Q

Benefits of intra-arterial BP include

A

rapid detection of BP fluctuations, more precise titration of vasoactive drugs and easy access for laboratory sampling

32
Q

Where should the transducer of the arterial BP be placed?

A

the level of the right atrium

33
Q

If you’re concerned about measuring cerebral perfusion pressure, you can zero the transducer at

A

the external auditory meatus (this corresponds to the circle of Willis)

34
Q

If your a-line is optimally damped, the baseline is re-established after

A

1 oscillation

35
Q

If your a-line is under-damped, the baseline is re-established after

A

several oscillations

36
Q

Causes of an under-damped waveform include

A

stiff (non-compliant) tubing and catheter whip (artifact)

37
Q

If your a-line is over-damped, baseline is re-established with

A

no oscillations

38
Q

Causes of an over-damped waveform include

A

air bubble in the pressure tubing, a clot in the catheter, low flush bag pressure, kinks, and a loose connection

39
Q

When inserting a central line in the right internal jugular vein, how far should the catheter be advanced to achieve correct placement?
a. 10 cm
b. 15 cm
c. 20 cm
d. 25 cm

A

b. 15 cm

40
Q

The tip of the CVP catheter should rest just above

A

the junction of the vena cava and the right atrium (not inside the RA)

41
Q

The tip of the PA catheter should reside in the

A

pulmonary artery, distal to the pulmonic valve (25-35 cm from the VC junction)

42
Q

Complications of central line placement can occur while

A

obtaining venous access, during catheter residence or while floating a PA catheter

43
Q

Accessing the left IJ carries the highest risk of injuring the

A

thoracic duct (risk of chlyothorax)

44
Q

__________________ are the most common complication while obtaining access.

A

Dysrhythmias

45
Q

Don’t float a PAC in the patient with

A

a left bundle branch block

46
Q

The classic presentation of pulmonary artery rupture is

A

Hemoptysis

47
Q

The incidence of catheter-related infection increases after

A

three days

48
Q

Placing the CVP into the cardiac chambers increases the risk of

A

dysrhythmias, thrombus formation, and cardiac perforation

49
Q

How far should you insert a central venous catheter in the right subclavian?

A

10 cm

50
Q

How far should you insert a CVC in the left internal jugular?

A

20 cm

51
Q

How far should you insert a CVC in the femoral?

A

40 cm

52
Q

How far should you insert a CVC in the right median basilic?

A

40 cm

53
Q

How far should you insert a CVC in the left median basilic?

A

50 cm

54
Q

The best way to treat dysrhythmias as a result of CVC access is to

A

withdraw the catheter and start over

55
Q

What patient factors increase the risk of pulmonary artery rupture?

A

anticoagulation, hypothermia, & advanced age

56
Q

What provider factors increase the risk of pulmonary artery rupture?

A

inserting the catheter too far, prolonged balloon inflation, chronic irritation of vessel wall, unrecognized wedging, and filling the balloon with liquid instead of air

57
Q

What are the complications associated with floating a PA catheter?

A

pulmonary artery rupture
right bundle branch block
complete heart block (if pre-existing LBBB)
dysrhythmias

58
Q

What are the complications possible while obtaining venous access?

A

arterial puncture
pneumothorax
air embolism
neuropathy
catheter knot

Apex Review (224 decks)

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