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RRT TMC > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

What is Hemodynamic Monitoring?

A

Hemodynamic monitoring is basically the assessment of several physiological parameters pertaining to the circulatory system.

It’s where we can measure blood pressure inside of the veins, arteries, and heart.

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2
Q

What is the normal Mean Arterial Pressure (MAP)

A

93 mmHg

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3
Q

What is the normal Central Venous Pressure (CVP)

A

2 – 6 mmHg

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4
Q

What is the normal Pulmonary Artery Pressure (PAP)

A

25/8 mmHg

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5
Q

What is the normal Pulmonary Capillary Wedge Pressure (PCWP)

A

4 – 12 mmHg

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6
Q

What is the Normal Systemic Vascular Resistance (SVR)

A

900 – 1400 dynes/sec/cm

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7
Q

What is the Normal Pulmonary Vascular Resistance (PVR)

A

150 – 300 dynes/sec/cm

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8
Q

What is the normal Cardiac Output (CO)

A

4 – 8 L/min

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9
Q

What is the normal Cardiac Index (CI

A

2 – 4 L/min/m2

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10
Q

What is a Strain-gauge Transducer?

A

It’s a pressure-measuring device that records pressures by the expansion and contraction of a flexible metal diaphragm connected to electrical wires.

Basically, in healthcare, we can use it to continuously monitor blood pressure.

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11
Q

What are the three values used to evaluate the forces influencing blood pressure?

A

(1) CVP (central venous pressure),
(2) PAP (pulmonary artery pressure), and
(3) PCWP (pulmonary capillary wedge pressure)

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12
Q

What three factors affect blood pressure?

A

(1) The condition of the left ventricle (the pump),
(2) The volume of blood in the cardiovascular system (the volume), and
(3) The relative size of the intravascular space (the space).

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13
Q

Which ventricle is composed of more muscle?

A

The left ventricle.

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14
Q

Where is the majority of the systemic blood stored in the body?

A

In the veins.

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15
Q

What happens during inspiration?

A

The drop in negative pressure in the thorax from -2 to -5 helps suck blood back toward the heart.

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16
Q

What is the Swan-Ganz catheter?

A

An invasive method of measuring pressure within the heart and lungs

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17
Q

What is another name for the Swan-Ganz catheter?

A

The triple lumen catheter.

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18
Q

What is shock?

A

It is a lack of blood flow to any tissues/organs in the body.

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19
Q

What is the distal lumen?

A

The fluid-filled line that transmits a wave of pressure from the tip of the catheter to the transducer.

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20
Q

What is a transducer?

A

A device that converts one form of energy to another.

The transducer converts the pressure signal to an electrical signal then sends it on to the monitor.

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21
Q

What does the monitor amplify?

A

It amplifies the signal and displays digital readings and/or a waveform.

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22
Q

What does the distal port communicate with?

A

The pulmonary artery.

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23
Q

Which chamber of the heart does the pulmonary artery come out of?

A

The right ventricle.

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24
Q

If the catheter is properly inserted, where does it rest?

A

In a pulmonary arteriole.

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25
Q

What can the distal port help us measure?

A

Problems that originate in the lungs. For example, pulmonary edema

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26
Q

What is PCWP?

A

It stands for pulmonary capillary wedge pressure.

It reflects what is going on with the left side of the heart.

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27
Q

What happens when the balloon is inflated?

A

It wedges in an arteriole and is able to obtain a pressure.

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28
Q

Where is the closest location that we can get to the left side of the heart?

A

The pulmonary arteriole.

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29
Q

The proximal port is also known as what?

A

The central venous pressure port.

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30
Q

Where is the CVP port located?

A

At the top of the right side of the heart, where the superior vena cava goes into the right atrium.

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31
Q

The lumen opens how many centimeters from the catheter’s port?

A

30 cm

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32
Q

How is cardiac output measured?

A

By injecting a bolus of saline at a known temperature that is less than the body’s, into the proximal lumen.

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33
Q

What does the SVO2 measurement tell us?

A

How much oxygen the body is using.

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34
Q

What is a normal SVO2 value?

A

70%

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35
Q

What measurement is the closest to the left side of the heart?

A

PCWP

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36
Q

What is the formula for cardiac output?

A

CO = HR x SV

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37
Q

Where can you obtain the PaO2?

A

In a blood gas sample.

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38
Q

Where can you find the PVO2?

A

Mixed venous blood obtained from the distal (PA) port of a Swan-Ganz catheter.

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39
Q

Where is the SVO2 obtained from?

A

The optical module connector in the top of the line Swan-Ganz catheter.

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40
Q

VO2 is the amount of what?

A

Oxygen that the body extracts from the blood every minute in order to feed the tissues.

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41
Q

What blood vessel comes in at the top of the right heart?

A

The superior vena cava.

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42
Q

What drains into the superior vena cava?

A

Internal jugular vein.

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43
Q

Where would the first choice be for the insertion of the Swan-Ganz catheter?

A

The internal jugular vein and subclavian vein because they are a direct shot into the right atrium (veins closest to the right side of the heart).

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44
Q

What pressure can be taken when the catheter is in the right atrium?

A

The central venous pressure (CVP).

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45
Q

What is a normal CVP?

A

The average = 0 – 5 mmHg.

The normal range = -2 – +12 mmHg.

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46
Q

After the catheter is in the right atrium, where does it go next?

A

Through the tricuspid valve into the right ventricle.

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47
Q

Why does the waveform change as soon as the catheter moves thru the tricuspid valve?

A

Because the pressure recorded within right ventricle is dramatically higher than within the right atrium.

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48
Q

What is a normal right ventricle pressure for systolic?

A

15-28 mmHg

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49
Q

What is a normal right ventricle pressure for diastolic?

A

0-8 mmHg

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50
Q

What is the normal systolic pulmonary artery pressure?

A

15-30 mmHg

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51
Q

What is the normal diastolic pulmonary artery pressure?

A

4-12 mmHg

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52
Q

What is the normal mean pulmonary artery pressure?

A

6-18 mmHg

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53
Q

What does the dicrotic notch represent?

A

The closure of the aortic & pulmonic valves @ the end of systole

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54
Q

What does it indicate when there is no dicrotic notch?

A

You may have to reposition the catheter or the patient was possibly moving.

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55
Q

What happens each time the mitral valve opens?

A

There is a direct communication between the catheter tip and the left ventricle via pulmonary capillary bed.

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56
Q

What is a normal mean of PCWP?

A

6-12 mmHg

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57
Q

How do we know if someone is in shock?

A

They will demonstrate the following:

decreased urinary output,
decreased blood pressure,
cyanotic,
temperature changes of skin and
cerebral perfusion compromise.

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58
Q

What does cardiogenic mean?

A

Beginning at the heart.

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59
Q

What is cardiogenic shock?

A

Left ventricular failing as a pump.

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60
Q

What pressure is closest to the left ventricle?

A

PCWP

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61
Q

Patients with CHF will have what?

A

An increased PCWP.

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62
Q

What is the most common cause of shock?

A

The inability of the left ventricle to produce adequate stroke volume.

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63
Q

What is stroke volume?

A

It is the amount of oxygenated blood pumped out of the heart during systole.

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64
Q

In an adult, what is the average volume for each heartbeat?

A

60 – 130 mL/beat.

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65
Q

What is an infarction?

A

Dead muscle.

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66
Q

What are some disorders that can cause cardiogenic shock?

A

(1) Infarction of more than 40% of the left ventricular muscle,
(2) CHF,
(3) Cardiac tamponade,
(4) Chest trauma.

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67
Q

What is cardiac tamponade?

A

Air or fluid in the pericardial sac.

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68
Q

How do you know that a patient has CHF based on their chest x-ray?

A

Measure the CT ratio and if it is > 50%, CHF is likely.

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69
Q

What happens when left ventricular failure gets worse?

A

Blood begins to back up into the left atrium.

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70
Q

What pressure is measured in pulmonary arteriole?

A

PCWP

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71
Q

Which factors are not affected by cardiogenic shock?

A

The skin’s color and temperature.

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72
Q

What does peripheral edema cause?

A

An increase in heart rate.

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73
Q

What can happen if you give a patient too much positive pressure on a ventilator?

A

It can cause cardiac tamponade (because it will squeeze the heart), among other things.

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74
Q

How is cardiac output affected in cardiogenic shock?

A

The left ventricle is failing so cardiac output is decreased.

75
Q

What drugs would you give to increase cardiac output?

A

Positive Inotropes (digitalis, digoxin), which will increase the contractility of the heart.

76
Q

What is the total amount of blood volume in the venous system is?

A

64%

77
Q

Venous return is the amount of blood volume returning to the?

A

Right heart.

78
Q

The patient cardiac index is the cardiac output based on what?

A

Actual body size.

79
Q

What is end-systolic pressure?

A

The amount of blood in the ventricle after ejection.

80
Q

What is end-diastolic pressure is?

A

The amount of blood in the ventricle after filling.

81
Q

What does cardiac tamponade do to blood entering the heart?

A

It restricts the blood entering the heart.

82
Q

What is the Fick equation?

A

CO= VO2/C(a-v)O2 x 10

83
Q

What is the normal right atrial pressure (RAP)?

A

2 to 6 torr.

84
Q

In general, PAP is concerning what?

A

The lungs.

85
Q

In general, PCWP is concerning what?

A

The left heart.

86
Q

In general, CVP is concerning what?

A

The right atrial pressure or fluid levels.

87
Q

The systemic artery blood pressure (SABP) generally looks at what?

A

The blood pressure throughout the body.

88
Q

What is preload?

A

The stretch on the ventricle muscle fibers before contraction.

89
Q

What is afterload?

A

The resistance of external factors that oppose ventricular contraction.

90
Q

Stroke volume is determined by what?

A

Preload, afterload, and contractility.

91
Q

A decrease in potassium and sodium causes what?

A

Atrial fibrillation.

92
Q

What is the procedure for placing an arterial line?

(9 steps)

A
  1. Assemble all equipment,
  2. perform the Allen’s test,
  3. drape the patient,
  4. inject 1% lidocaine,
  5. insert the catheter at a 30-degree angle,
  6. hold the needle and advance the catheter,
  7. remove the needle and secure,
  8. attach drip and
  9. observe the waveform.
93
Q

What is the procedure for placing a pulmonary catheter?

A

It is done by the physician,

  1. check the balloon for patency,
  2. it is inserted into a selected sight until it reaches the 3. right atrium,
  3. then inflate the balloon.
94
Q

What are the common sites for placing a pulmonary catheter?

A

Subclavian or internal jugular vein.

95
Q

What are the common sites for placing an arterial catheter?

A

Radial, brachial, or femoral arteries.

96
Q

What is Systemic Vascular Resistance?

A

It is the pressure on the vessel’s throughout the body (from the aorta).

97
Q

What is Pulmonary Vascular Resistance?

A

It is the pressure on the pulmonary artery.

98
Q

What factors affect the contractility of the heart?

A

Coronary blood flow, sympathetic nerve stimulation, Inotropic drugs, Physiologic depressants, damage to heart.

99
Q

What are the left atrial filling pressures?

A

Preload and PCWP.

100
Q

What are the right atrial filling pressures?

A

The amount of blood in the right atrium or CVP.

101
Q

What is MAP and what is the normal range?

A

It stands for mean arterial blood pressure and the normal value is 90 mmhg (80-100).

102
Q

What is CVP?

A

It stands for central venous pressure.

103
Q

What is PCWP and what is the normal range?

A

It stands for pulmonary capillary wedge pressure that the normal ranges is 5 – 10mm Hg (<18).

104
Q

What is an increased CVP associated with?

A

Fluid overload, right ventricular failure, hypercapnia,
valvular stenosis, PE, cardiac tamponade, pneumothorax, PPV, PEEP, left ventricular failure.

105
Q

What is associated with an increased PAP?

A

Pulmonary hypercapnia, left ventricular failure, fluid
overload.

106
Q

What is associated with an increased PCWP?

A

Left ventricular failure, fluid overload, > 20 interstitial edema, >25 alveolar filling, >30 pulmonary edema.

107
Q

What does an increase or decrease in CVP represent?

A

An increase represents fluid overload, L-R shunt, cor pulmonale. A decrease represents hypovolemic shock.

108
Q

Why should all blood pressure measurements be taken at the heart level?

A

To eliminate the effect of gravity on hydrostatic pressure.

109
Q

What is the definition of stroke volume?

A

The volume of blood ejected from the heart with each beat.

110
Q

How does heart rate affect diastolic pressure?

A

It changes the duration of diastole and the pressure continues to fall until the next systole.

111
Q

Low pulse pressures can indicate what two things?

A

CHF and shock.

112
Q

What is the average driving force in the arterial system throughout the cardiac cycle known as?

A

Mean arterial pressure

113
Q

MAP can be used to calculate what?

A

SVR and PVR

114
Q

What is the normal for MAP?

A

70-105

115
Q

An MAP below 60 indicates what?

A

Circulation to vital organs may be compromised and poor tissue perfusion.

116
Q

What are the indications for Arterial cannulation?

A

It’s indicated for hemodynamically unstable patients, patients on vasoactive drips, patients with IAB, and perioperative patients.

117
Q

What are the hazards of arterial cannulation?

A

Hemorrhage, thrombus, air embolism, systemic infection, site infection, arterial spasm, vascular occlusion.

118
Q

Why is invasive hemodynamic monitoring needed?

A

Because clinical assessment alone may not accurately predict hemodynamics.

119
Q

What must be considered before a catheter is placed in a patient?

A

The risk-benefit ratio of invasive monitoring.

120
Q

What is hemodynamic monitoring performed to do?

A

To evaluate the intravascular fluid volume, cardiac/vascular function; and to identify sudden changes in hemodynamics.

121
Q

Why is invasive monitoring needed?

A

To obtain an accurate evaluation of hemodynamics.

122
Q

What type of patient may a physician want to place an arterial catheter in?

A

Those with significant hemodynamic instability or the need for frequent arterial blood draws.

123
Q

What conditions are likely candidates for arterial pressure monitoring?

A

Severe hypotension (shock) or HTN; respiratory failure,

124
Q

What patient may benefit from arterial pressure monitoring?

A

Those in need of medication that affects blood pressure. Examples include vasodilators and inotropic agents.

125
Q

Where is the arterial catheter usually placed?

A

Radial, ulnar, brachial, axillary, femoral.

126
Q

Where is the arterial line most often placed and why?

A

The radial artery, because it is readily accessible/adequate collateral circulation.

127
Q

What is low blood pressure a late sign of?

A

Deficits in blood volume or cardiac function.

128
Q

What are the causes of hypotension?

A

Low blood volume (bleeding), cardiac failure/shock (heart attack), vasodilation (sepsis).

129
Q

During the administration of what drugs should the diastolic pressure be watched carefully?

A

Vasodilators, such as sodium nitroprusside.

130
Q

What are 6 causes of an increased central venous pressure?

A

Fluid overload, heart failure, pulmonary hypertension, tricuspid valve stenosis, pulmonary embolism, and increased venous return.

131
Q

What are the 4 causes of a decreased central venous pressure?

A

Vasodilation, reduced circulating blood volume, leaks in pressure system/air bubbles, spontaneous inspiration.

132
Q

When can pneumothorax occur during hemodynamic monitoring?

A

When the catheter punctures the pleural lining

133
Q

What can the accidental opening of the central venous line stopcock allow and result in?

A

Air to enter the vein which can cause an air embolus.

134
Q

What does the PAC allow the assessment of?

A

It allows the assessment of the filling pressures of the left side of the heart.

135
Q

What are pulmonary artery catheters also called?

A

Swan-ganz catheters

136
Q

What is the balloon at the tip of the catheter used for?

A

To float the catheter into position (into the right side of the heart and into the pulmonary artery) and obtain wedge pressure measurements.

137
Q

What can resistance to pulmonary flow (increased PVR) be caused by?

A

Constriction, obstruction, or compression of the pulmonary vasculature or backpressure from the left heart.

138
Q

What conditions cause an increased pulmonary vascular resistance?

A

Pulmonary emboli; acute/chronic lung disease; cardiac tamponade; left heart failure.

139
Q

What should be immediately available at both the insertion and removal of a pulmonary artery catheter?

A

Lidocaine and emergency resuscitation equipment.

140
Q

What should be optimized to decrease the risk of dysrhythmias?

A

Blood gases and serum electrolytes.

141
Q

What is not normal and is an indication for obtaining a chest x-ray to assess the cause?

A

Catheter resistance

142
Q

What are the factors that control blood pressure?

A

The heart, blood/fluid levels, and vessels.

143
Q

The amount of blood pumped out of the left ventricle in a minute is known as what?

A

Cardiac Output

144
Q

What is the cardiac Output normal range?

A

4 – 8 LPM

145
Q

What is the formula for Cardiac Output?

A

CO= HR X SV

146
Q

What is the volume or amount of blood ejected with each beat known as?

A

Stroke Volume

147
Q

What is the stroke volume normal range?

A

60 – 130 mL/beat

148
Q

What is the formula for stroke volume?

A

SV= CO / HR

149
Q

The amount of blood that is ejected from the heart depends on what 3 things?

A

Preload, afterload, and contractility.

150
Q

The right ventricle pumps against what?

A

Pulmonary vascular resistance.

151
Q

The left ventricle pumps against what?

A

Systemic Vascular Resistance.

152
Q

What happens when blood pressure is too low?

A

The tissues in the body won’t receive adequate oxygen.

153
Q

What happens when blood pressure is too high?

A

It causes a strain on the heart and will eventually cause failure.

154
Q

What is the pump that creates blood pressure?

A

The heart.

155
Q

The distal port samples what type of blood?

A

Mixed venous blood.

156
Q

What is the Respiratory Therapist’s job when assisting the physician with the insertion of a pulmonary artery catheter?

A

Set up the bag, zero, check the ports, inflate the balloon, and deflate the balloon.

157
Q

The central venous pressure measures what 3 things?

A

Intravascular volume, venous return, and right ventricle preload.

158
Q

What causes an increased central venous pressure?

A

Fluid overload, right ventricle failure, right sided valve disorders, cardiac tamponade, and obstructive RA tumor.

159
Q

What causes a decreased central venous pressure?

A

Hypovolemia and shock

160
Q

A PCWP that is greater than 18 may represent?

A

Pulmonary vascular congestion

161
Q

A PCWP that is greater than 30 may represent?

A

Pulmonary edema

162
Q

What causes an increased PCWP?

A

Left heart failure,
intravascular volume overload,
cardiac tamponade/effusion,
Obstructive LA tumor.

163
Q

What are the factors which can cause an increased PVR?

A

Hypoxemia, acidosis, PPV/PEEP & vasoconstrictors.

164
Q

What are the factors which can cause a decreased PVR?

A

Oxygen, Nitrogen, Alkalosis & vasodilators

165
Q

What are the factors which can cause an increased SVR?

A

Hypovolemia, certain shocks & vasoconstrictive drugs

166
Q

What are the factors which can cause a decreased SVR?

A

Vasodilators, morphine, certain shocks

167
Q

What are the normal values for CVP?

A

2 – 6 mmHg

168
Q

What are the normal values for RAP?

A

2 – 6 mmHg

169
Q

What are the normal values for RVP?

A

20-30 / 0-5 mmHg

170
Q

What are the normal values for PAP?

A

15-25 / 8-15 mmHg

171
Q

What are the normal values for MPAP?

A

10-20 mmHg

172
Q

What are the normal values for PCWP?

A

5-12 mmHg

173
Q

What are the normal values for MAP?

A

85-115 mmHg

174
Q

What are the normal values for PVR?

A

155 – 255 dynes*sec/cm5

175
Q

What are the normal values for SVR?

A

950 – 1300 dynes*sec/cm5

176
Q

How many lumens do PAC catheters have?

A

4-6

177
Q

Which part of the PAC rests in the right atrium for the CVP measurement?

A

The Proximal Lumen.

178
Q

Where does the distal lumen rest?

A

In the pulmonary artery.

179
Q

Which lumen measures the PAP, PCWP, and obtains mixed venous samples?

A

The distal lumen because it is in the pulmonary artery.

180
Q

When inserting a PAC, how do you know if it’s in the right atrium?

A

The pressure should read 2-6 mmHg.

181
Q

How does negative pressure affect the heart?

A

It increases venous return and preload.

182
Q

What can cause an increased PCWP?

A

Left ventricular failure, hypervolemia, mitral valve stenosis, and technical causes.

183
Q

What would be seen on a chest x-ray with a PCWP > 18 mmHg?

A

The onset of pulmonary vascular congestion.

184
Q

What would be seen on a chest x-ray with a PCWP > 25 mmHg?

A

Obvious pulmonary edema.

RRT TMC (3 decks)

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