Hemodynamic review part 2 Flashcards
What invasive monitoring will you use for hemodynamics?
CVP, Art line, and PA/swanz
What is the reference point for the transducer with all invasive monitoring?
Phlebostatic Axis, 4th IC
Why do we zero the lines?
We zero them so that there’s no possibility of the environment impacting the pressure readings
T/F
When zeroing the line, the transducer needs to be at the 6th IC.
False!
When you zero the line (and always) it should be at 4th IC phlebostatic axis
Zeroing the Lines:
When zeroing the stopcock, do you turn it to air or the patient?
Where will the zero function be located?
After you’ve zeroed it, what should you do?
Turn the stopcock to air
Zero function is on the monitor
Always make sure to confirm that the monitor reads zero
When do you absolutely have to zero the line?
When should you do it even if it ins’t a must?
You MUST do it during initial set up, immediately after you insert it, beginning of shift, and if there’s been any disconnection.
You definitely should do it when you question the value
What does the PA/PAWP pressure represent?
Indirect left atrial pressure
What does PVR mean?
What does PVR measure?
Normal values?
PVR = Pulmonary Vascular Resistance
PVR measures resistance of the pulmonary bed (sort of like how svr is systemic) that the RIGHT ventricle has to overcmoe
150-250 dynes
What is SVR?
What does SVR measure?
SVR means Systemic Vascular Pressure
SVR measures resistance of vascular bed or afterload.
(note: often described as the same thing as blood pressure)
800-1200 dynes
Which line can calculate CO/CI?
Swan
What is SVo2?
It means mixed venous oxygen saturation.
It tells us how much oxygen the arteries used after its taken a “round” around the circulatory system.
Normal range for CVP
What happens if the reading is low?
What if the reading is high?
0-8 mmhg
If the reading is low, it means they are dehydrated.
If reading is high, it means there’s HF going on & there holding onto too much fluid.
PA pressure range
When should Pulmonary artery measurement be taken?
15-25
8-15
Take at end of expiration.
PAWP range
6-12 mmhg
PVR/PVRI range
100-250 dynes/sec/cm
SVR range
800-1200 dynes
CO range
4-8 L/min
CI range
2-4 L/min
Three ways to obtain the CVP
Transduce a central line
Attach a water column
Use proximal lumen of the swan/pa line
Name three insertion sites to read CVP/preload
External jugular
Internal jugular
Subclavian in the chest
How does transthoracic pressure affect CVP/preload?
Spontaneous breathing - decrease CVP
Positive pressure vent (PEEP) - increase CVP
What can perforate with CVP monitoring?
Superior vena cava
- it is inserted there
What can the guidwirie cause when monitoring CVP?
Arrhythmias
- a. fib
- pvc
What other two complications can CVP monitoring cause?
Venous thrombosis
Infection
Your CVP decreases. What is a likely reason why?
If CVP decreases, that means there’s a loss of fluid or dehydration. Need to consider fluid deficit or hemorrhage from trauma
Your CVP increases. What do you need to consider?
If cvp increases, this means there’s too much fluid. Hypervolemia rt right sided heart failure is likely.
What cardiac reasons are there for someone to have an ART line?
Severe hypertension or hypotension. Either one.
What is a respiratory reason why someone would need an ART line?
Respiratory failure or Respiratory shock.
Medication reason that someone would need an ART line?
Use of pressor meds
- epi
- dopamine
What lab could be a reason someone needs an ART line?
ABG - we can get blood right off the art line.
Your patient has an art line. What do you need to assess hourly?
When do you call the doctor?
Assess neurovascular status distal to the insertion site which includes:
extremity temperature; you want warm! not cold.
cap refill
tingling or numbness
If a patient has any questionable symptoms, 1. tell patient not to move their hand and 2. then go call the doctor.
List equipment used for Art line
Pressure bag
Blood reservoir
Saline flush
T/F
You can give meds safely through an ART line
False. False. False. Never give meds through an art line.
What test can we use to secure an ART line site?
Allen’s test - hold hand up and clench/unclench hand while compressing the radial and ulnar arteries. Lower the hand and then quickly release to see if color returns back to the hand within 5-7 seconds. Collateral perfusion
Getting blood from ART line:
Which way should stopcock be turned when obtaining blood through an ART line?
Which port should you use?
Do you use the first sample of blood?
What is the last thing you should do?
Turn it off to the transducer for the art line
Use the port closest to patient
The first sample should be discard blood that you eventually return to patient with an art line.
Lastly, make sure to flush the line completely.
You are wanting to know if your ART line is getting accurate readings. You’ve aleady zeroed it and made sure its in line with 4th IC. How can you check that everything is accurate?
To check if an art line is accurate look at the waveform and search for the Dichotic Notch. It indicates aortic valve closure and is a good sign.
What can cause an art line disruption?
What can happen the the vessel itself?
What vascular compromise can occur?
What line identification errors can happen?
Disruption can be caused by positioning. We try to use a board but it’s not 100% effective.
The vessel can experience a vasospasm
Edema can occur
The line may not be labeled - always make sure to label your lines.
What causes an over damped dichotic notch for the art line?
Clot
Air bubble in tubing
What should you do if your notch is over damp?
Assess the patient
Reposition
Reassess
What can cause an underdamp dichotic notch?
Tubing is too long
Too many stopcocks
Tachycardia
How does an underdamp notch affect medication administration?
The systolic BP will be higher and the diastolic will be lower so cardiac meds can be hard to give if the reading is inaccurate
How do art line pressures and regular cuff pressures differ?
When are you supposed to do a cuff pressure when using an art line?
Art line is often 5-10 mmhg higher since its more accurate
- this can be due to the cuff not being the right size
Do cuff pressure at the begging of shift for accuracy
