Invasive Arterial BP

Question 1

Purpose of the Invasive arterial BP monitoring

Answer 1

beat to beat monitoring of BP
Allow for multiple ABG measurements
Monitoring of CO and SV when unable to place Pulmonary catheter

Question 2

2 Contraindications for A line

Answer 2

Smaller end arteries with inadequate collateral blood flow

Suspected vascular insufficiency

Question 3

Possible complications of A-line

Answer 3

Hematoma
Thrombosis with distal ischemia
Catheter embolism
Pseudoaneurysm
Systemic infection

Question 4

Factors that increase risk for complications

Answer 4

Multiple attempts
High dose vasopressor
Large bore catheters

Question 5

Best practice for A-line to prevent complications

2 interventions helpful

Answer 5

Continuous saline infusion 2-6ml /hr
flexible guidewire
Monitor pulse ox on the same side of the A-line

Question 6

When should femoral A-line be discontinued?

Answer 6

within 5 days

Question 7

When should A-line placed in sites other than femoral be D/C

Answer 7

Should not be changed on discontinued within 7 days

Question 8

What does the Allen test check

Answer 8

Integrity of the ulnar collateral circulation

Question 9

Steps to perform the allen test?

Answer 9

Ask the patient make a fist
Occlude both radial and ulnar arteries while patient
Relaxes blanched hand
Release pressure on the ulnar artery and flushing of the hand should occur within 5 seconds

Question 10

What indicates insufficient collateral circulation

Answer 10

Flushing after > 10 seconds

Question 11

If no flushing after 10 seconds

Answer 11

Test is NEGATIVE, DO NOT CANNULATE RADIAL ARTERY

Question 12

If flushing occur within 5 seconds

Answer 12

Test is POSiTiVE, may cannulate radial artery

Question 13

A-line Radial site and accuracy and one disadvantage

Answer 13

Radial site most commonly used, not accurate as it is distal from the heart.

Question 14

Arterial line site that may lead to peripheral neuropathy

Answer 14

Radial

Question 15

A-line Site more tortuous in its path

Answer 15

Ulnar

Question 16

A-line Site allows patient mobility and comfort

Answer 16

Axllary

Question 17

A-line site associated with Brachial Plexopathy?

Answer 17

Axillary

Question 18

What is the implications of more centrally located catheters?

Answer 18

Risk of cerebral air or emboli with vigorous retrograde flushing

Question 19

Associated with a less distorted waveform than more peripheral vessels , more prone to kinking

Answer 19

Brachial

Question 20

A-line largest artery

Answer 20

Femoral

Question 21

What is the site that more closely resemble the AORTIC pressure than peripheral sites such as the radial artery

Answer 21

Femoral

Question 22

What is the Seldinger technique?

Answer 22

The use of the Guidewire-assisted cannulation

Question 23

Position of the arm during radial a line insertion

Answer 23

Slight dorsiflexion

Question 24

Steps to insert radial a-line

Answer 24

artery is palpated
Skin prepared with antiseptic
Local anesthetics for patient comfort and reduction of vasospasm
Needle and catheter introduced in vessel
Proximal occlusion ->tubing connected –>sterile dsg

Question 25

The “fast flush” test is a method used at the | bedside to determine

Answer 25

the natural frequency and damping characteristics of the | transducing system.

Question 26

The transducer is placed at the level of the

Answer 26

RIGHT ATRIUM

Question 27

For beach chair or sitting position, transducer of a-line is commonly placed at the

Answer 27

Tragus of the ear to approximate the circle of willis and therefore cerebral pressure.

Question 28

Before initiating therapy, the transducer system should be

Answer 28

examined quickly and the patency of | the arterial cannula verified.

Question 29

2 conditions in which a line contraindicated

Answer 29

``` Reynaud phenomenon Thromboangiitis obliterans (Buerger disease), ```

Question 30

Fidelity of the transducer system is better when the

Answer 30

tubing are stiff mass of the fluid is small the number of stopcocks is limited, connecting tubing is not excessive

Question 31

Underdamped pressure system will

Answer 31

Overestimate BP by 15-30mmHg

Question 32

Overdamped pressure system will

Answer 32

Underestimate BP

Question 33

Critically ill newborn infants, the________ represents a convenient site for catheterization in order to measure arterial blood pressure and for blood sampling for laboratory values.

Answer 33

umbilical artery

Question 34

Should not be attempted in efforts to restore function to an apparently occluded indwelling arterial catheter. It is best to __________

Answer 34

High-pressure flushing Clear the line by hand with a small syringe, using the minimum pressure and volume necessary, as even small-volume flushes (0.5 to 1 mL)

Question 35

Small volume flushes even 0.5-1ml injected into the radial arteries of small infants using automated pressurizing systems may cause

Answer 35

retrograde flow into the cerebral vessels

Question 36

In arterial line monitoring, the slope of the upstroke indicates

Answer 36

Contractility

Question 37

In arterial line monitoring, the slope of the downstroke indicates

Answer 37

Peripheral vascular resistance

Question 38

Peripheral compared to central arterial waveform: arterial upstroke

Answer 38

STEEPER

Question 39

Higher systolic peak peripheral vs central

Answer 39

Peripheral

Question 40

Later dicrotic notch peripheral vs central

Answer 40

Peripheral

Question 41

* Usually the primary source of hand blood flow

Answer 41

Ulnar artery

Question 42

Brachial artery cannulation Danger! –

Answer 42

median nerve

Question 43

Femoral A-line

Answer 43

Must be careful to be below inguinal ligament