Lecture 6 - Monitoring equipment Flashcards
Practicalities of Central Venous Catheter (CVC)
delivers fluids/drugs
measures Central venous pressure
monitor changes during treatment
Practicalities of an Arterial line
- usually radial (can also be femoral/dorsalis pedis)
- radial line usually splinted to avoid excess movement
- arterial line used for ABG samples
Practicalities for a Pulmonary Artery Catheter - Swan Ganz
used for heart failure
medicaiton delivery
optimize fluid transport
can be used to assess left heart pressure
Intra-aortic balloon pump (IABP)
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
When does an assessment for suctioning occur
2nd hour in conjunction with auscultation
Name some indications for suctioning
visible/audible/palpable secretions
Increases RR, decreasing VT
increased HR/BP
Restless
In a normal expiratory effort, how much air is expired in 1 second (%)
80%
What is the procedure time for the suction catheter?
<15 secs
When is hyperinflation indicated?
mobilizing secretions, sputum plugs, volume loss, lung collapse
What are the main effects of hyperinflation
Improvements in lung compliance and sputum clearance
How often is ICU acquired weakness seen in mechanically ventilated pts? (%)
25-60%
Positive effects of early mobilization in ICU
peripheral mm strenght
resp mm strength
decreases length of ICU and hospital stay
indices physical function
What are the adverse effects of suctioning?
hypoxia
trauma to airway
cardiac arrhythmias
infection
What is a closed suction system? and what are the benefits
catheter is closed in a plastic case
benefits: protects us from patients with body fluids, minimize risk of infection,
Why use hyperinflation prior to and post suction?
before: to preoxygenate patient, increase ventilation and loosen secretions
after: to reoxygenate and reinflate
What is a mini-tracheostomy
a small tracheostomy without a cuff, inserted for easy clearance of secretions - pt can still breath and talk normally
what do you need to monitor during treatment with suctioning?
Sp02 BP Ausc MAP/ECG ICP
Define Manual hyperinflation.
application of a larger than VT breath with an anaesthetic or resuscitation circuit
Why use MHI? benefits.
improves gas mvmnt
treat segmental collapse
assist in removing secretions
encourage resp mm when synchronized with patient
Do not use MHI when ….
Patient has…
- pneumothorax
- # ribs/flail
- acute asthma
- unstable CVS
- high ICP
- pt coughing
- hypoxic drive to breath
Nasogastric tube
- 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
PiCCO Monitoring
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
IDC (Indwelling catheter)
- Measures the amount of urine produced
- soft tube that’s placed up the urethra and collects urine from the bladder
Name the different types of Respiratory Monitoring
Pulse Oximetry
ABG
EtCO2
Airway pressures
What are the different types of airway pressures?
- Peak inspiratory pressure (< 40cmH2O) (max pressure in a set Vt)
- Mean airway pressure (avg pressure over the entire ventilatory period)
- End Expiratory pressure (pressure @ end of expiratory phase)
