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Ngozi's Acute and Chronic Care II > Hemodynamics > Flashcards

Hemodynamics Flashcards

Exam 2

1
Q

What is Hemodynamics?

A

Forces that control blood flow through the body

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2
Q

What is the end goal of hemodynamics?

A

we use hemodynamics to identify and address problem to restore adequate tissue perfusion

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3
Q

What are compensatory mechanisms in hemodynamics?

A

Mechanisms that change hemodynamic forces

Think about increased heart rate, respiratory rate, and blood pressure

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4
Q

When do we use hemodynamic monitoring?

A

When compensatory mechanisms fail due to illness

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5
Q

What is the pathway of blood flow through the heart?

A

IVC/SVC -> RA -> tricuspid valve -> RV ->Pulmonic valve -> Pulmonary artery -> Lungs -> Pulmonary veins -> LA -> Mitral valve -> LV -> Aortic valve -> Aorta

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6
Q

What are arteries?

A

Strong, elastic, three-layered vessels.
Arteries dilate or constrict to meet metabolic demand.

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7
Q

What are capillaries?

A

Microscopic vessels, one cell-layer thick walls.

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8
Q

What are veins?

A

Weak, elastic, three-layered vessels with one-way valves help return blood to heart; low pressure system

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9
Q

What is the average amount of blood in an adult body?

A

5L

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10
Q

What do vasopressors and vasodilators act on?

A

Receptors in the middle muscle layer of the arteries and veins

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11
Q

What is the effect of vasopressors and vasodilators?

A

Causing contraction or expansion of arteries and veins

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12
Q

What does the body produce to change the diameter of arteries and veins?

A

Catecholamines

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13
Q

What is the heart?

A

Mechanical pump of cardiovascular system
Muscular components and one-way valves

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14
Q

What can cause heart failure?

A

Muscle or valve failure

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15
Q

How is muscle contraction controlled?

A

Electrical stimulation (ECG)

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16
Q

What factors affect valve function?

A

Pressures on the valves

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17
Q

What does electrical dysrhythmia cause?

A

Abnormal muscle contractions

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18
Q

What does valve dysfunction cause?

A

Failure of one-way flow of blood through the heart

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19
Q

What is valve function dependent on?

A

Pressure
low pressure is where you get value/pressure problems

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20
Q

What happens during the diastolic phase of the cardiac cycle?

A

Heart is at rest
Blood flows into the right and left atrium

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21
Q

Why are the tricuspid and mitral valves open during the diastolic phase?

A

Pressures in the atria and ventricles are the same

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22
Q

What happens during the active diastolic phase?

A

Atria contract and squeeze blood into the ventricles

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23
Q

What causes the tricuspid and mitral valves to close?

A

Ventricular pressure exceeds atrial pressure this is S1 and S2

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24
Q

What is the approximate contribution of complete atrial emptying to cardiac output?

A

~30% % of total cardiac output. (this is sometimes called the “atrial kick”

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25
Q

What defines the diastolic phase?

A

Ventricles at rest

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26
Q

What defines the systolic phase?

A

Ventricles working

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27
Q

How do high heart rates affect chamber filling?

A

Reduces amount of time and less pressure

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28
Q

What sends a signal for the ventricles to contract?

A

Electrical stimulation down the bundle branches and through the Purkinje fibers

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29
Q

What happens during the systolic phase of the cardiac cycle?

A

Ventricles squeeze and push blood forward through the pulmonic and aortic valves into the lungs and the aorta.

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30
Q

What causes the S2 heart sound?

A

the pressure in the arteries exceeds the pressure in the ventricles, the pulmonic and aortic valves snap shut

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31
Q

What is SBP?

A

Highest pressure in the systolic phase.

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32
Q

What is DBP?

A

Lowest pressure in the diastolic phase.

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33
Q

When does the heart perfuse the coronary arteries?

A

During the diastolic phase when the heart is at rest.

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34
Q

What is the formula for cardiac output?

A

CO = HR x SV

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35
Q

What factors can affect heart rate?

A

ANS stimulation, temperature, electrolytes, adrenal stimulation, catecholamine release

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36
Q

Slow HR can decrease CO…..

A

Slow HR can decrease CO if the body is unable to compensate with an increase in SV

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37
Q

Why can a fast heart rate decrease cardiac output?

A

The heart does not have enough time to fill with blood

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38
Q

What is stroke volume?

A

The amount of blood pumped by the heart in one beat

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39
Q

What factors can affect stroke volume?

A

Preload, afterload, and contractility

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40
Q

Decreased stroke volume decrease cardiac output…

A

Unless the body compensates with increased heart rate

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41
Q

What is the normal CO in adults?

A

4-8L

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42
Q

Why does a fast heart rate not give the heart enough time to fill?

A

Not enough time for valves to fill

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43
Q

What is preload?

A

Stretch on the ventricular myocardium at the end of diastole.
Volume and outside pressure dependent.

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44
Q

What is afterload?

A

Resistance against which the ventricle must overcome to push blood forward.
the downstream resistance that the heart must beat against.

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45
Q

What is contractility?

A

The strength of muscle contraction in the myocardium.

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46
Q

What effects preload?

A

Increased intrathoracic pressure reduces preload; High PEEP, pneumothorax, and drugs like nitroglycerine affect it. Right heart heavily depends on preload.

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47
Q

What increases afterload?

A

Stenotic valves, pulmonary hypertension, systemic hypertension, vasopressors, hypoxia, hypothermia.

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48
Q

What medications increase contractility?

A

Digoxin, Levophed, Dobutamine, Milrinone

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49
Q

What conditions decrease contractility?

A

Hypocalcemia, Hypoxia, Acidosis, Hypothermia

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50
Q

What are some examples of negative inotropic (weaken the force of the heartbeat) medications?

A

Amiodarone, Beta blockers, Calcium channel blockers, ACE inhibitors

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51
Q

What is Cardiac Output?

A

Volume of blood pumped by the left ventricle in 1 minute

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52
Q

What is Cardiac Index?

A

Volume of blood pumped by the left ventricle in 1 minute divided by body surface area

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53
Q

How can Cardiac Index be calculated?

A

CO/BSA=CI

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54
Q

What is the normal range for Cardiac Index?

A

2.5-4.2 L/min/m2

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55
Q

Why is Cardiac Index preferred over Cardiac Output?

A

Universal measurement regardless of body size

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56
Q

What are intracardiac pressures?

A

Pressures within the heart

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57
Q

CVP=RAP=RV diastolic during the passive diastolic phase of the cardiac cycle , RV systolic=PA systolic, PA diastolic=LAP=LV diastolic during the passive diastolic phase of the cardiac cycle, LV systolic = SBP in the aorta

A

intracardiac pressure

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58
Q

Normal Hemodynamic values for central venous pressure (CVP)

A

2-6 mm Hg
same as right atrium pressure
Pressure of blood in the right heart at the end of diastole. Preload of the right ventricle

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59
Q

Normal Hemodynamic values for pulmonary artery pressure (PAP)

A

15-25 mm Hg

PA diastolic=LAP=LV diastolic during the passive diastolic phase of the cardiac cycle

8-15 mm Hg

Blood pressure in the pulmonary artery. PA diastolic pressure is almost the same as PAOP, Safer than occluding PA cath.

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60
Q

Normal Hemodynamic values for pulmonary artery occlusive pressure (PAOP)

A

8-12 mm Hg
Pressure of blood in the left heart at the end of diastole. Preload of left ventricle.

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61
Q

What is the stroke volume amount?

A

60-130 mL/beat
Volume of blood ejected from LV with each heartbeat.

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62
Q

Normal Hemodynamic values for Systemic Vascular Resistance (SVR) (pressure in arteries) (left ventricle gov name)

A

770-1500 dynes/sec/m2
Resistance that LV must overcome to open aortic valve and push blood forward. Afterload of left ventricle.

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63
Q

Normal Hemodynamic values for Pulmonary Vascular Resistance (PVR) (right ventricle gov name)

A

< 250 dynes/sec/m2
Resistance that RV must overcome to open Pulmonic valve and push blood forward. Afterload of right ventricle.

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64
Q

Normal Hemodynamic values for Mean Arterial Pressure (MAP)

A

70-105 mm Hg
Average blood pressure over 1 cardiac cycle. Important for end organ perfusion

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65
Q

What increases as we move through the heart?

A

pressure

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66
Q

What is the normal range for ScvO2?

A

65%-85%
Can be drawn from the distal port of a central line or PICC line or CVP port of PA catheter.

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67
Q

What is the normal range for SvO2?

A

60%-75%
Can be drawn from distal port of PA catheter

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68
Q

What does a high ScvO2 or SvO2 value indicate?

A

Increased oxygen supply, decreased oxygen demand, or inability to extract oxygen from blood

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69
Q

What do low values of central venous oxygen saturation indicate?

A

Decreased oxygen supply or increased oxygen demand

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70
Q

Why is central venous oxygen saturation slightly higher?

A

Blood above the right atrium is measured

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71
Q

What does urine and EtCO2 give information on?

A

Cardia output

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72
Q

What is non-invasive hemodynamic monitoring?

A

Monitoring without invasive procedures

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73
Q

Why is cuff size important for NIBP?

A

To ensure accurate readings

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74
Q

What is the preferred measurement site for NIBP?

A

Upper arm

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75
Q

Can the forearm be used for NIBP?

A

Yes, but it’s less accurate

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76
Q

What is Jugular vein distention (JVD)?

A

Elevation of CVP

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77
Q

How is JVD measured?

A

Supine position with HOB at 30-45 degrees

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78
Q

What is lactic acid?

A

Byproduct of anaerobic metabolism

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79
Q

What does lactate measurement indicate?

A

Tissue perfusion
Anytime the tissues are without adequate oxygen lactic acid is produced
It is a measure of how poorly perfused the tissues are

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80
Q

What is the goal when trending lactate?

A

> 20% reduction every 2 hours until normal

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81
Q

What are the components of an invasive pressure monitoring system?

A

Invasive catheter, high-pressure noncompliant tubing, transducer with a stopcock, pressurized flush system, bedside monitor

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82
Q

What is the role of the transducer with a stopcock in the pressure monitoring system?

A

To convert the pressure into an electrical signal

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83
Q

What does the pressurized flush system do in the pressure monitoring system?

A

Maintains patency and clears any blood clots

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84
Q

What are invasive catheters?

A

Medical devices inserted into the body
Arterial lines
Central Venous Lines
Pulmonary Artery Catheters

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85
Q

What is high-pressure noncompliant tubing used for?

A

Hemodynamic monitoring

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86
Q

How many stopcocks should be used with high-pressure noncompliant tubing?

A

Less than three

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87
Q

Why is it recommended to minimize the number of stopcocks with high-pressure noncompliant tubing?

A

To reduce the risk of leaks and errors

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88
Q

What is a transducer?

A

Converts intravascular pressure into waveforms and numerical data

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89
Q

Why does a transducer need to be calibrated to atmospheric pressure?

A

To ‘zero’ the system

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90
Q

What is the reference point used for leveling?

A

The 3-way stopcock or ‘air-fluid interface’

91
Q

What is the purpose of a pressurized flush system?

A

Maintains patency of the tubing and catheter

92
Q

What is the pressure at which the bag is inflated?

A

300 mm Hg

93
Q

How much fluid continuously infuses per hour?

A

2-5 mL/hour

94
Q

What are the usual flush solutions used?

A

0.9% NS or Heparinized solutions

95
Q

What is a potential benefit of using heparin solutions?

A

Maintains catheter longer but increase risk for bleeding or Heparin‐induced thrombocytopenia (HIT)

96
Q

What is the purpose of a bedside monitoring system?

A

Provide visual display of waveforms and numeric information from the transducer

97
Q

What type of information does a bedside monitoring system provide?

A

Hemodynamic waveforms and numeric information

98
Q

What is one function of a bedside monitoring system?

A

Data storage for integration into patient chart

99
Q

What are the 4 major components of validating the accuracy of hemodynamic data?

A
  1. Patient positioning
  2. Leveling the air-fluid interface with the phlebostatic axis
  3. Zeroing the transducer
  4. Assessing the dynamic response (Square Wave Test)
100
Q

What is the recommended position for a patient when using the phlebostatic axis?

A

Supine

101
Q

Can the head of the bed be elevated and still give accurate readings?

A

Yes, up to 60 degrees

102
Q

What point should be used if the patient is side-lying?

A

4th intercostal space mid-sternal point

103
Q

When using the phlebostatic axis, what should you imagine about the patient’s body?

A

Transparent and level the air-fluid interface with the atria

104
Q

How can the need for frequent re-leveling of the transducer be eliminated?

A

By affixing it to the chest wall

105
Q

When should the transducer be leveled?

A

Each time the patient is repositioned

106
Q

What can a low transducer cause?

A

Falsely high pressures

107
Q

What can a high transducer cause?

A

Falsely low pressures

108
Q

When should you zero the transducer?

A

When the catheter is inserted, beginning of shift, when repositioning, and with major changes in hemodynamic status

109
Q

How can you validate the accuracy of the transducer’s readings?

A

Perform a square wave test

110
Q

What is the Phlebostatic Axis?

A

Mid-point A-P chest wall and 4th ICS

111
Q

What is an overdampened system?
[B]

A

No oscillations, slurred upstroke, or small undershoot

112
Q

What is optimally dampened?

A

small undershoot below baseline followed by one or two oscillations before returning to the normal wave form. Data is accurate.

113
Q

What are the consequences of an overdampened system?
[B]

A

Falsely low systolic and falsely high diastolic blood pressure

114
Q

What are the possible causes of an overdampened system?
[b]

A
  • Blood clots
  • air bubbles
  • loose connections
  • kinks in tubing
  • low flush solution
  • underinflated pressure bag
115
Q

What is an underdampened system?
[C]

A

Excessive oscillations after square wave

116
Q

What are the consequences of an underdampened system?
[C]

A

Falsely high systolic and falsely low diastolic blood pressure

117
Q

What are the possible causes of an underdampened system?

A

Excessive tubing length, too many stopcocks, unknown reasons, or patient anatomy

118
Q

When should the dynamic response test be performed?

A

After catheter insertion, at least once per shift, after drawing blood, and anytime the system is opened.

119
Q

What is the purpose of arterial lines?

A

To monitor arterial blood pressure directly

120
Q

What is the most common site for arterial line placement?

A

Radial artery

121
Q

Why are the femoral artery and dorsalis pedis not preferred sites for arterial line placement?

A

Considered ‘dirty’ sites

122
Q

What test should be performed before inserting a radial arterial line?

A

Allen test

123
Q

What are some complications of arterial lines?

A

Thrombosis, embolism, blood loss, infection

124
Q

What is the Allen test?

A

Performing a test to assess the patency of the radial and ulnar arteries.

125
Q

What can cause thrombosis in a continuous flush system?

A

Failure to maintain the continuous flush system.

126
Q

What can cause an embolism in a catheter system?

A

Formation of small clots, shearing of the catheter, or installation of air.

127
Q

When can blood loss occur in the system?

A

Anytime the system is disconnected the patient can bleed out significantly in a short amount of time

128
Q

What is a potential risk of using dirty sites?

A

Increased risk of infection.

129
Q

What are the assessments to routinely perform for arterial lines?

A

Color, temperature, pulse, sensation, and cap refill.

130
Q

How should the wrist be positioned when an arterial line is in place?

A

In a neutral position

131
Q

What should be done to ensure hemostasis when removing an arterial line?

A

Apply manual pressure until bleeding stops
(minimum of 5 minutes for radial artery).

132
Q

Is it appropriate to administer medications via an arterial line?

A

NO

133
Q

What is the arterial waveform?

A

The pulsatile representation of the pressure changes within an artery.

134
Q

What does the arterial waveform represent?

A

Pressure changes within an artery.

135
Q

What does the arterial line represent?

A

The left side of the heart
a camera looking back on the left side of the heart

136
Q
A
  1. Top number is where systolic is measured; The highest point of the arterial waveform is the systolic blood pressure the lowest point of the arterial waveform is the diastolic pressure.
  2. dicrotic notch vale closes and you get change in pressure; The dicrotic notch is indicative of aortic valve closure.
  3. is diastolic
  4. Up strokes indicate that pressure is increasing towards the camera down strokes indicate that pressure is decreasing.
137
Q

What do the up strokes on an arterial line indicate?

A

Increasing pressure

138
Q

What do the down strokes on an arterial line indicate?

A

Decreasing pressure

139
Q

What does the dicrotic notch indicate?

A

Aortic valve closure

140
Q

What is the highest point on an arterial waveform?

A

Systolic blood pressure

141
Q

What is the lowest point on an arterial waveform?

A

Diastolic pressure

142
Q

What is CVP?

A

An estimate of the preload of the right ventricle
Central Venous Pressure

143
Q

How do you measure CVP?

A

Hook the distal port of a CVC to the invasive pressure monitoring system

144
Q

When should CVP be measured?

A

At the end of expiration

145
Q

What are the normal CVP values?

A

2-6 mm Hg

146
Q

What is the relationship between CVP and RAP?

A

They are equal and can be used interchangeably

147
Q

What are the causes of high CVP/RAP?
Central venous pressure or right atrium pressure

A
  • Volume overload
  • Right Ventricular failure
  • Tricuspid or pulmonic valve failure
  • Pulmonary hypertension
  • Pulmonary embolism
  • Mechanical ventilation
148
Q

What are the causes of low CVP/RAP?

A

Venodilation, Hypovolemia

149
Q

What is the significance of a pulse pressure of 9%?

A

Indicative of ‘fluid responsiveness’

150
Q

What is the purpose of pulmonary artery catheters?

A

Measuring pressures in the pulmonary artery and left atrium.

151
Q

What can pulmonary artery catheters measure?

A

Cardiac output, pulmonary artery pressure, and central venous pressure.

152
Q

What is a PA catheter?

A

A pulmonary artery catheter used to monitor heart and lung function

153
Q

How is a PA catheter placed?

A

Inserted into a large vein, such as the jugular or femoral vein

154
Q

What can happen if the PA is occluded for too long?

A

Death

155
Q

What dysrhythmia can occur when the PA catheter is passed through the right ventricle?

A

V-tach

156
Q
A
  • Notice how the PAO waveform looks kinda like v-fib?
  • Ventricular dysrhythmias (V-tach) can occur when the provider passes the PA catheter through the right ventricle. This should be resolved once in the PA.
  • The PA waveform has a dicrotic notch… it is indicative of pulmonic valve closure.
157
Q

How is PA catheter placement verified?

A

Monitoring waveforms and CXR

158
Q

What does the dicrotic notch on the PA waveform indicate?

A

Pulmonic valve closure

159
Q

What is the usefulness of PA Hemodynamic Monitoring?

A

To assess left sided heart involvement or lung dysfunction

160
Q

How does Thermodillution or continuous CO catheters help in PA Hemodynamic Monitoring?

A

They allow direct measurement of cardiac output

161
Q

Where does the proximal port of the PA catheter lie and what is measured?

A

In the right atrium, measures RAP and can be used for medication administration

162
Q

Where does the distal port of the PA catheter lie and what is measured?

A

In the pulmonary artery, measures PA pressures

163
Q

Where is blood drawn for mixed venous oxygen samples?

A

Distal port

164
Q

What is PAOP measurement?

A

PA occlusive pressure
when balloon is briefly inflated

165
Q

Is PAOP measurement risky for patients?

A

Yes

166
Q

What can be used as a substitute for PAOP measurement?

A

PA diastolic

167
Q

When should pressures be measured?

A

At the end of exhalation

168
Q

What are some risks associated with the PA catheter?

A

Arrhythmia, RBBB, PA injury/rupture

169
Q

What should you do if a patient experiences arrhythmia during PA catheter insertion?

A

Support the patient and remove the catheter if the arrhythmia does not resolve

170
Q

What can happen if a patient already has LBBB and develops RBBB during PA catheter insertion?

A
  • Complete heart block can occur
  • Be prepared to pace the patient
171
Q

What is the most significant risk associated with the PA catheter?

A

Pulmonary artery injury/rupture

172
Q

How does pulmonary artery injury/rupture present?

A

Episode of hemoptysis (when you cough up blood from your lungs) after catheter insertion or balloon inflation

173
Q

What are three conditions in which the risk is highest when inserting a PA catheter?

A

Pulmonary hypertension, hypothermia, and anticoagulation.

174
Q

What are two causes of PA rupture?

A

Overinflation of the balloon or migration of the catheter.

175
Q

What precautions should be taken when using a PA catheter?

A
  • Assess insertion depth frequently
  • only inflate balloon when ordered and necessary
  • lock balloon inflation port when not in use
  • use only the syringe that comes with the PA catheter.
176
Q

What is the maximum amount of air that should be used to inflate the balloon?

A

1.5ml

177
Q

What are the complications of central venous lines?

A
  • Pneumothorax/Hemothorax
  • Air Embolism
  • Laceration/Perforation of major vessels
  • Accidental placement in the carotid artery
  • Infection
178
Q

What should you do if pneumothorax/hemothorax occurs?

A

Prepare to insert a chest tube if present

179
Q

When can air embolism occur?

A

If connections are not tight, especially during insertion and removal of the line

180
Q

How should a patient be positioned if air embolism occurs? [Occurs most during line removal]

A

Trendelenberg on left side, give 100% O2

181
Q

What should you do if laceration/perforation of major vessels occurs and a hematoma forms?

A

Hold direct pressure and notify physician

182
Q

What should you do if central venous line is accidentally placed in the carotid artery?

A

Never remove the line, must be removed by vascular surgeon

183
Q

What is the most common and deadly complication of central venous lines?

A

Infection

184
Q

What is one way to reduce central line-associated infection?

A

Hand hygiene

185
Q

What should be used when inserting lines to reduce central line-associated infection?

A

Maximum sterile barriers

186
Q

What should be done to the skin prior to inserting the line to reduce central line-associated infection?

A

Prep with CHG scrub

187
Q

What are the preferred sites for line insertion to reduce central line-associated infection?

A

Subclavian, IJ, femoral

188
Q

What should be done to minimize the duration of line use to reduce central line-associated infection?

A

Remove lines as soon as possible

189
Q

What should be maintained on the site to reduce central line-associated infection?

A

Intact dressing

190
Q

What type of dressings can be used at the insertion site to reduce central line-associated infection?

A

CHG-impregnated dressings

191
Q

What should be done prior to all access of CVC ports to reduce central line-associated infection?

A

Scrub the hub

192
Q

What is one method of bathing that can help reduce central line-associated infection?

A

Daily CHG bathing

193
Q

What are some causes of increased CO/CI (cardia output and index)?

A
  • Elevated HR
  • increased preload
  • decreased afterload
  • increased contractility
194
Q

What are some causes of decreased CO/CI?

A
  • Inadequate ventricular filling
  • decreased preload
  • increased afterload
  • decreased contractility
195
Q

What can cause an elevated heart rate and increased CO/CI?

A
  • Activity
  • anemia
  • metabolic demand (e.g. seizures or shivering)
  • adrenal disorders
  • fever
  • anxiety
196
Q

How can preload be increased to increase CO/CI?

A

Stroke volume increase as a result of:
Fluid resuscitation or changes in ventricular compliance

197
Q

How can afterload be decreased to increase CO/CI?

A

Stroke volume increase as a result of:
Vasodilation from medications or sepsis, decreased blood viscosity (anemia), hypermetabolic states

198
Q

What can cause inadequate ventricular filling and decreased CO/CI?

A

HR that is too fast or too slow

199
Q

What can decrease preload and lead to decreased CO/CI?

A

Stroke volume reduction as a result of:
Hemorrhage, hypovolemia, vasodilation, fluid shifts

200
Q

How can afterload be increased to decrease CO/CI?

A

Stroke volume reduction as a result of:
Vasoconstriction or increased blood viscosity

201
Q

What can decrease contractility and result in decreased CO/CI?

A

Stroke volume reduction as a result of:
Myocardial infarction/ischemia, heart failure, cardiomyopathy, cardiogenic shock, cardiac tamponade

202
Q

What is thermodilution cardiac output?

A

Measurement of CO using a thermistor and injection of room temperature 0.9% NS

203
Q

How is thermodilution cardiac output measured?

A

Injection of a set volume of room-temperature NS into the proximal port of the PA catheter

204
Q

What does the thermistor measure?

A

Temperature of the blood

205
Q

How is the cardiac output calculated?

A

By calculating the area under the curve created by the temperature measurements

206
Q

Why is an average of several injections taken?

A

To obtain a more accurate measurement of cardiac output

207
Q

What should not be infused into the proximal port if thermodilution CO is being used?

A

Meds

208
Q

When should the solution be injected?

A

At the end of expiration

209
Q

What does thermodilution cardiac output measure?

A

Temp in body and averages the results

210
Q

What is Thermodilution Cardiac Output?

A

Measurement of cardiac output using a temperature-based method

211
Q

What is Continuous Cardiac Output?

A

Measurement of CO through thermal filament and thermistor

212
Q

How is CO measured using the thermal filament and thermistor?

A

By creating a washout curve based on temperature changes

213
Q

How long is the average taken for CO measurement?

A

Over 60 seconds

214
Q

Why is it not useful in hyperthermic patients?

A

Thermal filament only heats blood up to 44 degrees C maximum

215
Q

Are PA catheters worth it?

A

Use of PA catheters has decreased since evidence suggested that their use increased mortality

216
Q

What do PA catheter pressures estimate?

A

PA catheter pressures estimate preload

217
Q

What can affect PA catheter pressures?

A

Outside forces such as stiff ventricles or increased PEEP

218
Q

Should CVP be used as a sole decision-making point regarding fluid management?

A

No

219
Q

What has research shown regarding mortality in patients managed with a PAC vs. those managed without a PAC?

A

No difference in mortality

220
Q

Where is hemodynamic monitoring shifting?

A

Towards non-invasive monitoring and new devices that measure SV and changes in SV

221
Q

What are pulse contour methods of hemodynamic assessment?

A

Monitor attaches to an arterial line and measures variation in stroke volume

222
Q

What is the advantage of pulse contour methods over a PA catheter?

A

Less risk

223
Q

What is pulse contour method’s predictability for fluid responsiveness?

A

Better predictor

224
Q

What is the requirement for using pulse contour methods?

A

Full mechanical ventilation

Ngozi's Acute and Chronic Care II (4 decks)

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