Hemodynamic review part 2

Question 1

What invasive monitoring will you use for hemodynamics?

Answer 1

CVP, Art line, and PA/swanz

Question 2

What is the reference point for the transducer with all invasive monitoring?

Answer 2

Phlebostatic Axis, 4th IC

Question 3

Why do we zero the lines?

Answer 3

We zero them so that there’s no possibility of the environment impacting the pressure readings

Question 4

T/F

When zeroing the line, the transducer needs to be at the 6th IC.

Answer 4

False!
When you zero the line (and always) it should be at 4th IC phlebostatic axis

Question 5

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?

Answer 5

Turn the stopcock to air

Zero function is on the monitor

Always make sure to confirm that the monitor reads zero

Question 6

When do you absolutely have to zero the line?

When should you do it even if it ins’t a must?

Answer 6

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

Question 7

What does the PA/PAWP pressure represent?

Answer 7

Indirect left atrial pressure

Question 8

What does PVR mean?

What does PVR measure?

Normal values?

Answer 8

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

Question 9

What is SVR?

What does SVR measure?

Answer 9

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

Question 10

Which line can calculate CO/CI?

Answer 10

Swan

Question 11

What is SVo2?

Answer 11

It means mixed venous oxygen saturation.

It tells us how much oxygen the arteries used after its taken a “round” around the circulatory system.

Question 12

Normal range for CVP

What happens if the reading is low?

What if the reading is high?

Answer 12

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.

Question 13

PA pressure range

When should Pulmonary artery measurement be taken?

Answer 13

15-25

8-15

Take at end of expiration.

Question 14

PAWP range

Answer 14

6-12 mmhg

Question 15

PVR/PVRI range

Answer 15

100-250 dynes/sec/cm

Question 16

SVR range

Answer 16

800-1200 dynes

Question 17

CO range

Answer 17

4-8 L/min

Question 18

CI range

Answer 18

2-4 L/min

Question 19

Three ways to obtain the CVP

Answer 19

Transduce a central line

Attach a water column

Use proximal lumen of the swan/pa line

Question 20

Name three insertion sites to read CVP/preload

Answer 20

External jugular

Internal jugular

Subclavian in the chest

Question 21

How does transthoracic pressure affect CVP/preload?

Answer 21

Spontaneous breathing - decrease CVP

Positive pressure vent (PEEP) - increase CVP

Question 22

What can perforate with CVP monitoring?

Answer 22

Superior vena cava

• it is inserted there

Question 23

What can the guidwirie cause when monitoring CVP?

Answer 23

Arrhythmias

• a. fib
  
  • pvc

Question 24

What other two complications can CVP monitoring cause?

Answer 24

Venous thrombosis

Infection

Question 25

Your CVP decreases. What is a likely reason why?

Answer 25

If CVP decreases, that means there’s a loss of fluid or dehydration. Need to consider fluid deficit or hemorrhage from trauma

Question 26

Your CVP increases. What do you need to consider?

Answer 26

If cvp increases, this means there’s too much fluid. Hypervolemia rt right sided heart failure is likely.

Question 27

What cardiac reasons are there for someone to have an ART line?

Answer 27

Severe hypertension or hypotension. Either one.

Question 28

What is a respiratory reason why someone would need an ART line?

Answer 28

Respiratory failure or Respiratory shock.

Question 29

Medication reason that someone would need an ART line?

Answer 29

Use of pressor meds

• epi
  
  • dopamine

Question 30

What lab could be a reason someone needs an ART line?

Answer 30

ABG - we can get blood right off the art line.

Question 31

Your patient has an art line. What do you need to assess hourly?

When do you call the doctor?

Answer 31

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.

Question 32

List equipment used for Art line

Answer 32

Pressure bag

Blood reservoir

Saline flush

Question 33

T/F

You can give meds safely through an ART line

Answer 33

False. False. False. Never give meds through an art line.

Question 34

What test can we use to secure an ART line site?

Answer 34

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

Question 35

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?

Answer 35

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.

Question 36

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?

Answer 36

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.

Question 37

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?

Answer 37

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.

Question 38

What causes an over damped dichotic notch for the art line?

Answer 38

Clot

Air bubble in tubing

Question 39

What should you do if your notch is over damp?

Answer 39

Assess the patient

Reposition

Reassess

Question 40

What can cause an underdamp dichotic notch?

Answer 40

Tubing is too long

Too many stopcocks

Tachycardia

Question 41

How does an underdamp notch affect medication administration?

Answer 41

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

Question 42

How do art line pressures and regular cuff pressures differ?

When are you supposed to do a cuff pressure when using an art line?

Answer 42

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