Lecture 6 - Monitoring equipment

Question 1

Practicalities of Central Venous Catheter (CVC)

Answer 1

delivers fluids/drugs
measures Central venous pressure
monitor changes during treatment

Question 2

Practicalities of an Arterial line

Answer 2

• usually radial (can also be femoral/dorsalis pedis)
• radial line usually splinted to avoid excess movement
• arterial line used for ABG samples

Question 3

Practicalities for a Pulmonary Artery Catheter - Swan Ganz

Answer 3

used for heart failure
medicaiton delivery
optimize fluid transport
can be used to assess left heart pressure

Question 4

Intra-aortic balloon pump (IABP)

Answer 4

femoral artery insertion
linked to ECG
improves myocardial and systemic blood flow /o2 delivery
assists in myocardial perfusion
assissts ejection of blood from heart to improve myocardial circulation

Question 5

When does an assessment for suctioning occur

Answer 5

2nd hour in conjunction with auscultation

Question 6

Name some indications for suctioning

Answer 6

visible/audible/palpable secretions
Increases RR, decreasing VT
increased HR/BP
Restless

Question 7

In a normal expiratory effort, how much air is expired in 1 second (%)

Answer 7

80%

Question 8

What is the procedure time for the suction catheter?

Answer 8

<15 secs

Question 9

When is hyperinflation indicated?

Answer 9

mobilizing secretions, sputum plugs, volume loss, lung collapse

Question 10

What are the main effects of hyperinflation

Answer 10

Improvements in lung compliance and sputum clearance

Question 11

How often is ICU acquired weakness seen in mechanically ventilated pts? (%)

Answer 11

25-60%

Question 12

Positive effects of early mobilization in ICU

Answer 12

peripheral mm strenght
resp mm strength
decreases length of ICU and hospital stay
indices physical function

Question 13

What are the adverse effects of suctioning?

Answer 13

hypoxia
trauma to airway
cardiac arrhythmias
infection

Question 14

What is a closed suction system? and what are the benefits

Answer 14

catheter is closed in a plastic case

benefits: protects us from patients with body fluids, minimize risk of infection,

Question 15

Why use hyperinflation prior to and post suction?

Answer 15

before: to preoxygenate patient, increase ventilation and loosen secretions
after: to reoxygenate and reinflate

Question 16

What is a mini-tracheostomy

Answer 16

a small tracheostomy without a cuff, inserted for easy clearance of secretions - pt can still breath and talk normally

Question 17

what do you need to monitor during treatment with suctioning?

Answer 17

Sp02
BP
Ausc
MAP/ECG
ICP

Question 18

Define Manual hyperinflation.

Answer 18

application of a larger than VT breath with an anaesthetic or resuscitation circuit

Question 19

Why use MHI? benefits.

Answer 19

improves gas mvmnt
treat segmental collapse
assist in removing secretions
encourage resp mm when synchronized with patient

Question 20

Do not use MHI when ….

Answer 20

Patient has…

• pneumothorax
• # ribs/flail
• acute asthma
• unstable CVS
• high ICP
• pt coughing
• hypoxic drive to breath

Question 21

Nasogastric tube

Answer 21

• flexible tube that goes via nose/mouth and into stomach
• removes bodily fluids from stomach to prevent vomiting/aspiration
• to delive meds/food when the pt is ventilated/can’t swallow

Question 22

PiCCO Monitoring

Answer 22

Pulse Contour Cardiac Monitorying

• continuous
• gives a lot of info about cardiac function
• for a very sick patient
  > used in shock, sepsis, major surgery, cardiac dysfunction, ARDS
• 2 catheters needs - central venous and femoral catheter

Question 23

IDC (Indwelling catheter)

Answer 23

• Measures the amount of urine produced

- soft tube that’s placed up the urethra and collects urine from the bladder

Question 24

Name the different types of Respiratory Monitoring

Answer 24

Pulse Oximetry
ABG
EtCO2
Airway pressures

Question 25

What are the different types of airway pressures?

Answer 25

1. Peak inspiratory pressure (< 40cmH2O) (max pressure in a set Vt)
2. Mean airway pressure (avg pressure over the entire ventilatory period)
3. End Expiratory pressure (pressure @ end of expiratory phase)