Hemodynamic Monitors & Equipment Flashcards by Prop Papi

Optimal BP bladder length

80% of the extremity circumference

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Optimal BP bladder width

40% of the extremity circumference

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If the BP cuff location is above the heart, the BP reading will be:

Falsely decreased (there is less hydrostatic pressure).

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If the BP cuff location is below the heart, the BP reading will be:

Falsely increased (there is more hydrostatic pressure).

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A cuff that is too small will

overestimate SBP

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A cuff that is too large will

underestimate SBP

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Upstroke of arterial waveform represents

Contractility

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Peak of arterial waveform represents

Systolic BP

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Dicrotic notch of arterial waveform represents

Aortic valve closure

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Peak value minus trough value of arterial waveform represents

Pulse pressure

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Trough of arterial waveform represents

Diastolic BP

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What are the characteristics of an under-damped system?
(SBP, DBP, MAP)

SBP is overestimated, DBP is underestimated, and the MAP is accurate.

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What are the characteristics of an over-damped system? (SBP, DBP, MAP)

SBP is underestimated, DBP is overestimated, and MAP is accurate.

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A wave of a CVP waveform represents

Right atrial contraction

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C wave of a CVP waveform represents

Right ventricular contraction (bulging of tricuspid valve into RA)

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X descent of a CVP waveform represents

RA relaxation

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V wave of a CVP waveform represents

Passive filling of RA

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Y descent of a CVP waveform represents

RA empties through open tricuspid valve

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Are these causes of an under or over damped waveform?
Air bubble in the tubing
Clot in the catheter
Low flush bag pressure
Kinked tubing
Loose connection

Over-damped

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Are these causes of an under or over damped waveform?
Stiff tubing
Catheter whip (artifact)

Under-damped

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Right internal jugular CVC catheter length

15 cm

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Left internal jugular CVC catheter length

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Tip of CVC catheter should reside at

Junction of vena cava and right atrium

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Distance from vena cava/right atrial junction to right atrium

0 - 10 cm

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Distance from vena cava/right atrial junction to right ventricle

10 - 15 cm

Distance from vena cava/right atrial junction to pulmonary artery

15 - 30 cm

Distance from vena cava/right atrial junction to PAOP position

25 - 35 cm

A wave and EKG

Just after P wave (atrial depolarization)

C wave and EKG

Just after QRS complex (ventricular depolarization)

X descent and EKG

ST segment

V wave and EKG

Just after T wave begins (ventricular repolarization)

Y descent and EKG

After T wave ends

How does PEEP affect central venous pressure (CVP)?

Increases it (creates additional resistance against RV ejection)

How does pericardial tamponade affect central venous pressure (CVP)?

Increases it (produces a compressive force around the heart. This reduces RA compliance)

Increase a wave amplitude is caused by (2)

stenotic tricuspid valve or decreased compliance of the right ventricle.

What wave form is lost in the CVP waveform during afib?

A wave, loss of atrial kick

How does tricuspid regurgitation affect the CVP waveform?

Large V wave due to regurgitant blood re-entering RA

How does tricuspid stenosis affect the CVP waveform?

Large A wave

Normal RAP

1 - 10

Normal RVP

15/0 -30/8

Normal PAP

15/5 - 30/15

Normal PAOP

5 - 15

In which lung West zone should the tip of the pulmonary artery catheter be placed? (Enter your answer as a whole number)

West Zone 1

PA > Pa > Pv

West Zone 2

Pa > PA > Pv

West Zone 3

Pa > Pv > PA

Why should the tip of the PA catheter be positioned in zone 3?

There's a continuous column of blood between the tip of the PAC and the left ventricle (LVEDP reflects back through the pulmonary circulation).

List 3 things that suggest the tip of the PA catheter is not in zone 3.

PAOP > pulmonary artery end-diastolic pressure Nonphaseic PAOP tracing Inability to aspirate blood from the distal port when the balloon is in the wedged position

PAOP overestimates LVEDV in these conditions (2)

PEEP and diastolic dysfunction

PAOP underestimates LVEDV in this condition

Aortic insufficiency

When would it be preferential to measure CO using the standard thermodilution technique over continuous cardiac output?

In a hemodynamically unstable patient (due to a delay time between measurement and the data appearing on the monitor).

What is the normal value for SvO2?

65 - 75%

Why do you need a PA catheter to measure SvO2?

A true mixed venous sample must contain blood returning from the superior vena cava, inferior vena cava, and the coronary sinus. The pulmonary artery is the best place to get the sample.

The SvO2 decreases if

oxygen consumption increases or oxygen delivery decreases.

Preload responsiveness is expected to be present if a 250 mL fluid bolus increases the stroke volume in excess of:

10%

When using pulse contour analysis, preload responsiveness can be assumed when:

A 200 - 250 mL fluid bolus improves SV more than 10%.

Which 2 conditions limit the reliability of the esophageal Doppler monitor?

Aortic stenosis Aortic cross-clamp placement

What is a contraindication to the esophageal Doppler?

Esophageal disease

In which position is a non-invasive blood pressure cuff MOST likely to overestimate cerebral perfusion pressure?

Reverse Trendelenburg

In which condition will the left ventricular end-diastolic volume be more than what is predicted by the PAOP value?

Aortic insufficiency

What is the MOST accurate measurement provided by the oscillometric method of blood pressure measurement?

Mean arterial pressure

Which 2 phases of the cardiac cycle correlate with the a wave?

Ventricular diastole. Atrial systole.

Normal PAP systolic range

15 - 30 mmHg

Normal PAP diastolic range

5 - 15 mmHg

When performing direct blood pressure measurement, where is the pulse pressure expected to be the LARGEST?

Dorsalis pedis artery

Which 2 components of the CVP waveform correlate with ventricular systole?

x descent. c wave.

Which 2 components of the CVP waveform correlate with ventricular diastole?

a wave. y descent.

BP cuff near aortic root (SBP/DBP/PP)

SBP is lowest, DBP is highest, and PP is narrowest

BP cuff near dorsalis pedis (SBP/DBP/PP)

SBP is highest, DBP is lowest, and PP is widest

Central venous pressure is MOST accurately measured at the:

end of expiration.

What are the 3 peaks of the CVP waveform?

a, c, v waves

What are the 2 troughs of the CVP waveform?

x, y descent

What changes will you see when the PA catheter is in the pulmonary artery?

A dicrotic notch and rise in diastolic pressure

What branch block can be caused by PA catheter placement?

Right Bundle Branch Block