ICU Monitoring Lines & Tubes

Question 1

What is P/F ratio

Answer 1

• PaO2 via ABG to fraction of inspired O2 (FiO2)
• Normal: ~400-500 mmHg
• P/F ratio < 200-300 mmHg indicates possible need for mechanical ventilation
• P/F ratio <150 indicates severe hypoxemia

Question 2

ECG indications of declining cardiac status

Answer 2

• ST change (elevation or depression)
• Onset, increase, or change of foci of premature ventricular contractions
• Onset of V-tachy or Vfib
• Onset of atrial flutter or fibrillation
• Progression of heart block
• Loss of pacer spike

Question 3

Pulmonary artery catheter (Swan-Ganz) allows monitoring of the following

Answer 3

• Direct measurement of Right Atrial Pressure (RAP)
• Direct measurement of pulmonary arterial pressure (PAP) and pulmonary capillary wedge pressure (PCWP)
• Indirect measurement of left atrial pressure (LAP)
• Determination of mixed venous oxygen saturation (SvO2) and cardiac output (CO)
• Calculation of systemic and pulmonary vascular resistance (PVR)
• Pacing of the atrium and ventricles

Question 4

Why are pulmonary capillary wedge pressures monitored

Answer 4

• Assess severity of left ventricular failure
• Assess mitral and aortic valve dysfunction
• Assess and treat pulmonary edema (PCWP >20 mm Hg)
• Assess pulmonary hypertension
• Assess and treat hypovolemic state

Question 5

Complications of insertion and dislodgment of the Swan-Ganz catheter include

Answer 5

• Malignment arrhythmias
• Pulmonary artery rupture
• Pulmonary valve tear
• Infection

Question 6

Describe mobilizing a patient with a Swan-Ganz catheter

Answer 6

• When deciding to mobilize a patient with a pulmonary artery catheter, note the location of the catheter, assure its security, note the waveform and rhythm, and ensure patient cooperation.
• During the intervention observe the rhythm and the patient closely.

Question 7

Activities that may increase ICP (intra-cranial pressure)

Answer 7

• Isometric exercise
• Valsalva maneuver
• Extreme hip flexion
• Lateral neck flexion
• Coughing
• Prone position
• Head position below 15 degrees horizontal (ideal position for venous drainage: HOB >30 degrees)
• Occlusion of the tube
• Pain

Question 8

For effective mobilization of patients with a chest tube includes

Answer 8

• Ensure that the patient is premedicated for pain.
• Always keep chest tube drainage system below the chest level.
• Check for air leaks (air bubbles will be present in the underwater seal compartment if air leaks are present).
• Always discuss with doctor or nurse before disconnecting suction.
• A portable suction device may be used when indicated.
• Changes in the quantity and quality of exudates should be noted by the physical therapist before, during, and after changes in position and therapeutic interventions
• After the chest tube is removed, hold therapy until radiography rules out pneumothorax.