ICU 2B

Question 1

3 important factors when measuring haemodynamics

Answer 1

1. accuracy
2. interpretation + knowledge
3. a correct response to the reading

Question 2

Equipment needed

Answer 2

Transducer
Amplifier
Monitor / Recorder

Question 3

Transducer

Answer 3

Converts fluid waves into electrical

signals

Question 4

Amplifier

Answer 4

Increases the size of the electrical signal

Question 5

Monitor / Recorder

Answer 5

Displays the signal and saves

data

Question 6

Calibration of Equipment

Answer 6

Leveling

Zeroing

Question 7

Leveling

Answer 7

Transducer at the level of
right atrium (phlebostatic
axis = 4th intercostal space
mid axilla)

Question 8

Zeroing

Answer 8

• Atmospheric pressure

Question 9

Complications

Answer 9

The most common complication is infection, hence the importance of ANTT.
Micro-organisms can migrate down the transducer line and rest at the insertion
site causing swelling (phlebitis), redness or pus; thus causing trauma to the
artery, possibly its collapse, and increasing the risk of sepsis.

Question 10

Other complications include:

Answer 10

• Arterial wall puncture/Haematoma/Thrombosis
• Disconnection/haemorrhage/sanguination
• Sepsis
• Vascular insufficiency
• Arterial spasm

Question 11

Arterial Line reflects the patients BP

Answer 11

MAP = mean arterial pressure (somewhere between 60-85mmHg)

Question 12

Central Venous Pressure generally reflects the patient’s fluid status

Answer 12

CVP = 3 – 8 mm Hg
• Low CVP = hypovolaemia or ↓ venous return
• High CVP = overhydration, or ↑ venous return (right-sided heart
failure)

Question 13

Central Venous Catheters

Answer 13

Measures the pressures in the right atrium.
• Used to assess right ventricular function and
venous blood return to heart.

Question 14

CVP / Right Atrial Pressures

Answer 14

Reflection of right
ventricular filling pressures (preload)
• Increased CVP = fluid overload
• Decreased CVP = hypovolaemia

Question 15

Triple Lumen CVC
Proximal port
Medial port
Distal port

Answer 15

hole closest to point of entry (18g, white)
18g (blue)
furthest away from entry point (used for CVP measurement, 16g –generally brown)

Question 16

Nursing Implications

Answer 16

• Check unit policy (usually requires competency)
• Sterile dressing changes
• Tubing, caps and fluid bag changes as per policy
• Flush lumens; never tie off !
• Unused should be saline locked (not heparin)
• Withdraw blood before injection (to ensure
patency and to avoid pushing clot into patient).

Question 17

Complications

Answer 17

• Local infection à sepsis
• Air embolism
• Pneumothorax/ haemothorax
• Blocked / clotted off
• Cardiac arrhythmias
• Damage to vein or adjacent structures
• Haemorrhage

Question 18

The pulmonary artery catheter (PAC)

Answer 18

is a balloon
tipped thermo dilution catheter, that is inserted via
a large vein and floated into the pulmonary artery.
It is used to obtain haemodynamic measurements
which together with clinical observations indicate
how efficiently the heart is functioning.

Question 19

Indications for a PAC

Answer 19

1. To assess cardiovascular status: CCF, complicated MI, cardiac
   tamponade, monitoring post cardiac bypass graft surgery
2. Shock (all types)
3. Assessment of pulmonary status: Acute respiratory failure,
   pulmonary hypertension, pulmonary oedema
4. To assess fluid status and requirements: burns, sepsis
5. Major systems dysfunction

Question 20

Nursing Implications

Answer 20

• Check patient position
• spontaneous ventilation - record end inspiration
• positive ventilation - record end expiration
• dysrhythmias
• dampened trace
• kink or knot
• Beware of spontaneous wedge (balloon inflates
and gets stuck)

Question 21

Nursing Management of Pressure Lines

Answer 21

• Don’t become complacent …….these lines carry
potential fatal consequences for the patient if they
are not managed correctly
• Observe all sites for infection
• Don’t ever inject into an artery - could mean
amputation!
• Ensure NO air gets in the lines (not even a tiny bit!)
• Secure all lines and label correctly