If the BP cuff location is above the heart, the BP reading will be: hemodynamic monitors & equipment

falsely decreased there is less hydrostatic pressure section 1 flashcard

If the BP cuff location is below the heart, the BP reading will be: hemodynamic monitors & equipment

falsely increased there is more hydrostatic pressure section 1 flashcard

Hemodynamic Monitors & Equipment 6.4 Flashcards by Kelly K

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

hemodynamic monitors & equipment

b. requires less pressure to occlude the artery

pre-lesson Q1

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Etiologies of an over-damped arterial line waveform include: (Select 2)
a. air bubbles in the pressure bag
b. low flush bag pressure
c. improper zero location
d. loss of dicrotic notch

hemodynamic monitors & equipment

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

pre-lesson Q2

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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

hemodynamic monitors & equipment

b. 15 cm

pre-lesson Q3

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Which component of the CVP waveform is shown in the image?
a. A wave
b. C wave
c. V wave
d. P wave

hemodynamic monitors & equipment

a. A wave

pre-lesson Q4

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Central venous pressure is:
a. falsely increased by placing the transducer above the zero point
b. increased by PEEP
c. decreased by pericardial tamponade
d. unchanged by a ventricular septal defect

hemodynamic monitors & equipment

b. increased PEEP

pre-lesson Q5

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Which conditions increase the amplitude of the a wave on the CVP waveform? (Select 2)
a. tricuspid stenosis
b. atrial fibrillation
c. diastolic dysfunction
d. tricuspid regurgitation

hemodynamic monitors & equipment

a. tricuspid stenosis
c. diastolic dysfunction

pre-lesson Q6

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In which lung zone should the tip of the pulmonary artery catheter be placed?

hemodynamic monitors & equipment

zone 3

pre-lesson Q8

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When does pulmonary artery occlusion pressure overestimate left ventricular end-diastolic volume? (Select 2)
a. PA catheter tip in West zone 3
b. PEEP
c. diastolic dysfunction
d. aortic insufficiency

hemodynamic monitors & equipment

b. PEEP
c. diastolic dysfunction

pre-lesson Q9

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Which situation underestimates cardiac output obtained by the thermodilution method?
a. over warmed injectate
b. right-to-left intracardiac shunt
c. high injectate volume
d. partially wedged pulmonary artery catheter

hemodynamic monitors & equipment

c. high injectate volume

pre-lesson Q10

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Factors that increase mixed venous oxygen saturation include: (Select 2)
a. thyroid storm
b. sodium nitroprusside toxicity
c. anemia
d. sepsis

hemodynamic monitors & equipment

b. sodium nitroprusside toxicity
d. sepsis

increase SvO2

pre-lesson Q11

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

hemodynamic monitors & equipment

10%

pre-lesson Q12

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Which conditions limit the reliability of the esophageal Doppler monitor? (Select 2).
a. hypovolemia
b. aortic stenosis
c. aortic cross-clamp placement
d. esophageal disease

hemodynamic monitors & equipment

b. aortic stenosis
c. aortic cross-clamp placement

pre-lesson Q13

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In which condition will the left ventricular end-diastolic volume be more than what is predicted by the PAOP value?
a. aortic insufficiency
b. left-to-right cardiac shunt
c. chronic obstructive pulmonary disease
d. myocardial ischemia

hemodynamic monitors & equipment

a. aortic insufficiency

post lesson quiz

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When performing direct blood pressure measurement, where is the pulse pressure expected to be the largest?
a. femoral artery
b. dorsalis pedis artery
c. aorta
d. radial artery

hemodynamic monitors & equipment

b. dorsalis pedis artery

post lesson quiz

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Which pressure constitutes a normal value based on a PAC in the pulmonary artery?
a. 8 mmHg
b. 18/3 mmHg
c. 22/9 mmHg
d. 40/18 mmHg

hemodynamic monitors & equipment

c. 22/9 mmHg

post lesson quiz

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Which interventions most likely cause increased height in the esophageal Doppler?
a. phenylephrine
b. norepinephrine
c. clevidipine
d. esmolol

hemodynamic monitors & equipment

c. clevidipine

post lesson quiz

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An absent a wave in the CVP waveform is consistent with:
a. right ventricular papillary muscle ischemia
b. tricuspid stenosis
c. atrial fibrillation
d. AV dissociation

hemodynamic monitors & equipment

c. atrial fibrillation

post lesson quiz

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Which phases of the cardiac cycle correlate with the a wave? (Select 2)
a. ventricular diastole
b. ventricular systole
c. atrial diastole
d. atrial systole

hemodynamic monitors & equipment

a. ventricular diastole
d. atrial systole

post lesson quiz

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Which components of the CVP waveform correlate with ventricular systole? (Select 2)
a. c wave
b. a wave
c. y descent
d. x descent

hemodynamic monitors & equipment

a. c wave
d. x descent

post lesson quiz

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In which position is a non-invasive blood pressure cuff most likely to overestimate cerebral perfusion pressure?
a. lateral decubitus
b. reverse trendelenburg
c. supine
d. trendelenburg

hemodynamic monitors & equipment

b. reverse trendeleburg

post lesson quiz

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What is the most accurate measurement provided by the oscillometric method of blood pressure measurement?
a. pulse pressure
b. systolic pressure
c. mean arterial pressure
d. diastolic pressure

hemodynamic monitors & equipment

c. mean arterial pressure

post lesson quiz

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When preparing to transition off cardiopulmonary bypass, the SvO2 decreases from 64% to 56%. What are the most likely etiologies of this finding? (Select 2)
a. hypothermia
b. initiation of dobutamine infusion
c. light anesthesia
d. anemia

hemodynamic monitors & equipment

c. light anesthesia
d. anemia

post lesson quiz

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

hemodynamic monitors & equipment

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

section 12 flashcard

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List 6 situations where pulse contour analysis won’t provide reliable data.

hemodynamic monitors & equipment

spontaneous ventilation
small tidal volume
PEEP
open chest
right ventricular dysfunction
dysrhythmias

section 12 flashcard

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What are the optimal measurements for the blood pressure bladder length and width? ## Footnote hemodynamic monitors & equipment

length: 80% of the extremity circumference width: 40% of the extremity circumference ## Footnote section 1 flashcard

If the BP cuff location is above the heart, the BP reading will be: ## Footnote hemodynamic monitors & equipment

falsely decreased | there is less hydrostatic pressure ## Footnote section 1 flashcard

If the BP cuff location is below the heart, the BP reading will be: ## Footnote hemodynamic monitors & equipment

falsely increased | there is more hydrostatic pressure ## Footnote section 1 flashcard

What are the characteristics of an under-damped system? ## Footnote hemodynamic monitors & equipment

SBP is overestimated, DBP is underestimated, and the MAP is accurate ## Footnote section 2 flashcard

List 2 causes of an under-damped system. ## Footnote hemodynamic monitors & equipment

1. stiff tubing 2. catheter whip (artifact) ## Footnote section 2 flashcard

What are the characteristics of an over-damped system? ## Footnote hemodynamic monitors & equipment

SBP is underestimated, DBP is overestimated, and MAP is accurate ## Footnote section 2 flashcard

List 5 causes of an over-damped system. ## Footnote hemodynamic monitors & equipment

1. air bubble in the tubing 2. clot in the catheter 3. low flush bag pressure 4. kinked tubing 5. loose connection ## Footnote section 2 flashcard

What is the approximate distance between each CVP catheter insertion site and the vena cava/right atrial junction? a. right internal jugular vein b. left internal jugular vein c. right subclavian vein d. left subclavian vein e. left femoral vein f. right median basilic vein ## Footnote hemodynamic monitors & equipment

a. 15 cm b. 20 cm c. 10 cm d. 10 cm e. 40 cm f. 40 cm ## Footnote section 3 flashcard

What mechanical and electrical cardiac event correlates with each segment of the CVP waveform. a. *a* wave b. *c* wave c. *x* descent d. *v* wave e. *y* descent ## Footnote hemodynamic monitors & equipment

a. right atrial contraction; just after P wave b. tricuspid elevation into the RA; just after the QRS complex c. downward movement of contracting RV; ST segment d. RA passive filling; just after T wave begins e. RA empties through open tricuspid valve; after T wave ends ## Footnote section 4 flashcard

What factors increase CVP? ## Footnote hemodynamic monitors & equipment

RV failure PEEP cardiac tamponade tricuspid stenosis tricuspid regurgitation ## Footnote section 5 flashcard

What factors decrease CVP? ## Footnote hemodynamic monitors & equipment

transducer above the phlebostatic axis hypovolemia ## Footnote section 5 flashcard

What is normal central venous pressure in an adult? ## Footnote hemodynamic monitors & equipment

1-10 mmHg ## Footnote section 5 flashcard

During which part of the respiratory cycle should CVP be measured? ## Footnote hemodynamic monitors & equipment

end-expiration ## Footnote section 5 flashcard

What factors lead to the loss of an *a* wave? ## Footnote hemodynamic monitors & equipment

atrial fibrillation v-pacing if the underlying rhythm is asystole ## Footnote section 6 flashcard

What factors lead to a large *a* wave? ## Footnote hemodynamic monitors & equipment

tricuspid stenosis diastolic dysfunction myocardial ischemia chronic lung disease leading to RV hypertrophy AV dissociation junctional rhythm v-pacing (asynchronous) PVCs ## Footnote section 6 flashcard

What factors lead to a large *v* wave? ## Footnote hemodynamic monitors & equipment

tricuspid regurgitation acute increase in intravascular volume RV papillary muscle ischemia ## Footnote section 6 flashcard

In the context of West zones, where should the tip of the PA catheter reside? ## Footnote hemodynamic monitors & equipment

Zone 3 ## Footnote section 8 flashcard

Why should the tip of the PA catheter be positioned in zone 3? ## Footnote hemodynamic monitors & equipment

there's a continous column of blood between the tip of the PAC and the left ventricle ## Footnote section 8 flashcard

List 3 things that suggest the tip of the PA catheter is not in zone 3. ## Footnote hemodynamic monitors & equipment

1. PAOP > pulmonary artery end-diastolic pressure 2. nonphaseic PAOP tracing 3. inability to aspirate blood from the distal port when the balloon is in the wedged position ## Footnote section 8 flashcard

What factors overestimate LVEDP? ## Footnote hemodynamic monitors & equipment

impaired LV compliance mitral valve disease (stenosis or regurg) left-to-right cardiac shunt tachycardia PPV PEEP COPD PHTN non West Zone 3 placement of PAC ## Footnote section 9 flashcard

What factors underestimate LVEDV? ## Footnote hemodynamic monitors & equipment

aortic valve insufficiency ## Footnote section 9 flashcard

What conditions underestimate CO? ## Footnote hemodynamic monitors & equipment

injectate volume too high injectate solution too cold ## Footnote section 10 flashcard

What conditions overestimate CO? ## Footnote hemodynamic monitors & equipment

injectate volume too low injectate solution too hot partially wedged PAC thrombus on tip of PAC ## Footnote section 10 flashcard

What conditions affect the reliability of a CO measurement but are unpreditable? ## Footnote hemodynamic monitors & equipment

intracardiac shunt tricuspid regurgitation ## Footnote section 10 flashcard

What is the formula for SvO2? ## Footnote hemodynamic monitors & equipment

SaO2 - (VO2 / (Q x 1.34 x Hgb x10)) ## Footnote section 11 flashcard

What is the normal value for SvO2? ## Footnote hemodynamic monitors & equipment

65-75% ## Footnote section 11 flashcard

Why do you need a PA catheter to measure SvO2? ## Footnote hemodynamic monitors & equipment

A true mixed venous sample must contain blood returning from the SVC, IVC, and the coronary sinus. The pulmonary artery is the best place to get the sample. ## Footnote section 11 flashcard

What factors lead to decreased SvO2 by increased O2 consumption? ## Footnote hemodynamic monitors & equipment

stress pain thyroid storm shivering fever ## Footnote section 11 flashcard

What factors lead to decreased SvO2 by decreased O2 delivery? ## Footnote hemodynamic monitors & equipment

decreased PaO2 decreased Hgb decreased CO ## Footnote section 11 flashcard

What factors lead to increased SvO2 by decreased O2 consumption? ## Footnote hemodynamic monitors & equipment

hypothermia cyanide toxicity ## Footnote section 11 flashcard

What factors lead to increased SvO2 by increased O2 delivery? ## Footnote hemodynamic monitors & equipment

increased PaO2 increased Hgb increased CO ## Footnote section 11 flashcard

List 6 conditions that cause inaccurate readings with the esophageal Doppler. ## Footnote hemodynamic monitors & equipment

1. aortic stenosis 2. aortic insufficiency 3. disease of the thoracic aorta 4. aortic cross-clamping 5. after CPB 6. pregnancy ## Footnote section 12 flashcard

What changes would you expect if you move the non-invasive blood pressure cuff from the upper arm to the calf? (Select 3) a. systolic BP increases b. systolic BP decreases c. diastolic BP increases d. diastolic BP decreases e. pulse pressure increases f. pulse pressure decreases ## Footnote hemodynamic monitors & equipment

a. systolic BP increases d. diastolic BP decreases e. pulse pressure increases ## Footnote review exam

Match each component of the EKG to the corresponding event on the CVP waveform. 1. T wave 2. P wave 3. ST segment 4. QRS complex a. *c* wave b. *v* wave c. *x* descent d. *a* wave ## Footnote hemodynamic monitors & equipment

1b 2d 3c 4a ## Footnote review exam

Central venous pressure is most accurately measured at the: a. beginning of inspiration b. beginning of expiration c. end of inspiration d. end of expiration ## Footnote hemodynamic monitors & equipment

d. end of expiration ## Footnote review exam

Match each component of the CVP waveform to its corresponding mechanical event. 1. *c* wave 2. *a* wave 3. *v* wave 4. *x* descent a. right atrial relaxation b. right ventricular contraction c. right atrial contraction d. right atrium passive filling ## Footnote hemodynamic monitors & equipment

1b (c wave = RV contraction) 2c (a wave = RA contraction) 3d (v wave = RA filling) 4a (x descent = RA relaxation) ## Footnote review exam

Which conditions increase the amplitude of the *v* wave on the CVP waveform? (Select 2) a. complete heart block b. papillary muscle ischemia c. right ventricular hypertrophy d. tricuspid regurgitation ## Footnote hemodynamic monitors & equipment

b. papillary muscle ischemia d. tricuspid regurgitation ## Footnote review exam

When inserting a centrla line into the left 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 ## Footnote hemodynamic monitors & equipment

c. 20 cm ## Footnote review exam

What is the distance from the junction of the vena cava and the right atrium to the tip of a PA catheter placed in the PA distal to the pulmonic valve? a. 10 cm b. 20 cm c. 40 cm d. 60 cm ## Footnote hemodynamic monitors & equipment

b. 20 cm | 15-30 cm ## Footnote review exam

Which of the following is observed as the tip of the pulmonary artery catheter enters the right ventricle? (Select 2) a. there is a dicrotic notch b. the systolic pressure increases c. the pulse pressure increases d. the diastolic pressure increases ## Footnote hemodynamic monitors & equipment

b. the systolic pressure increases c. the pulse pressure increases ## Footnote review exam

All of the following are complications of pulmonary artery catheter placement except: a. pneumothorax b. air embolism c. neuropathy d. left bundler branch block ## Footnote hemodynamic monitors & equipment

d. left bundle branch block | increased risk of RBBB; do not place PAC in pre-existing LBBB ## Footnote review exam

Factors that decrease mixed venous oxygen saturation include: (Select 2) a. left-to-right shunt b. fever c. cyanide toxicity d. seizure ## Footnote hemodynamic monitors & equipment

b. fever d. seizure | increased O2 consumption or decreases oxygen delivery ## Footnote review exam