Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

8361 Exam I > Mod1: Monitoring for Cardiac Surgery - CENTRAL VENOUS PRESSURE > Flashcards

Mod1: Monitoring for Cardiac Surgery - CENTRAL VENOUS PRESSURE Flashcards

1
Q

CENTRAL VENOUS PRESSURE - INDICATIONS

Secures vascular access for:

A

Evaluating cardiac function

CVP/RAP (preload)

To evaluate R atrial and ventricular function and tricuspid function

Administer fluids, vasoactive drug therapy, TPN fluid

Aspiration of air

Conduit for insertion pulmonary artery catheter or transcutaneous pacing leads

Difficult vascular access or repeated blood sampling required

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

CENTRAL VENOUS PRESSURE - INDICATIONS

T/F: CVP/RAP is a good indicator of left sided function

A

False

CVP/RAP is not a good indicator of left sided function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CENTRAL VENOUS PRESSURE - INDICATIONS

What are normal CVP/RAP values?

A

2-6 mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What must be carefully considered when choosing a site for CVP cannulation?

A

Patient’s underlying medical condition

Clinical setting and skill level of anesthesia provider

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What should be considered when selecting a site for CVP cannulation in a pt with underlying bleeding process

A

choose a site where bleeding from the vein or surrounding vessels can easily be detected and corrected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Between Internal jugular and subclavian approach which is preffered for CVP cannulation in a pt with Bleeding diatheses?

A

Internal jugular > subclavian approach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What is Bleeding diatheses?

A

an unusual susceptibility to bleed (hemorrhage) mostly due to hypocoagulability (a condition of irregular and slow blood clotting), in turn caused by a coagulopathy (a defect in the system of coagulation).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Between Internal jugular and subclavian approach which is preffered for CVP cannulation in a pt with Emphysema?

A

Internal jugular > subclavian approach

IJ is associated with a reduced chance of a pneumothorax

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Why is the RIJ preferred for Transvenous pacing?

A

Direct route to right ventricle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Provider must be aware of the length of the catheter chosen in relation to the site of insertion. How many cm greater will proper positioning of the cather tip in th SVC be on the left vs the right?

A

3-5 cm greater on the left than right

This is why left sided catheter should be longer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What’s the most common site for CVP cannulation

A

Right internal jugular vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What are advantages of the right IJ site for CVP cannulation?

A

Easily accessible (short/direct access to the RA)

Predictable anatomy

Good landmarks

High success rate (>90%)

Thrombus formation less likely (d/t high blood flow rate and pts can still move heads arround)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Which complications are associated with the right IJ when used as a CVP cannulation site?

A

Carotid artery puncture

Brachial plexus injury

Pneumothorax (esp. pts w/ short necks)

Hard to maintain sterility (esp. in pts w/ lots of oral seceretions)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Advantages of Left internal jugular vein site?

A

Same as right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What are “catheter length” considerations when the Left IJ is cannulated for CVP monitoring?

A

A longer catheter may be needed for the catheter to be seated in the right position

Remember that proper position of the catheter tip in the SVC will be 3-5cm greater on the left than on the right

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Disadvantages of Left internal jugular vein site?

A

Thoracic duct damage

Cupola of the pleura higher on left side

(which potentially increase the risk for a pneumothorax)

Left IJ is smaller than the right IJ

Difficulty maneuvering catheter through jugular-SC junction

Carotid artery puncture

(LIJ seats more on top of the left carotid than the right IJ seats on top of the right carotid)

Embolization of dominant L cerebral hemisphere

Most providers have less experience with inserting lines on the left side

(Which creates and increased risk for adverse events)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Why is the risk of Thoracic duct damage greater with LIJ cannulation than with RIJ cannulation?

A

The Thoracic duct enters the venous system at the junction of the LIJ vein and the subclavian vein, so it can potentially be damaged

This is not the case on the right side because the thoracic duct typycally drains into the venous system at the level of the subclavian vein; so the risk of injury is lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

Where do thoracic ducts terminate? What’s the difference between Left vs right terminations?

A

On the left side, the Thoracic duct enters the venous system at the junction of the LIJ vein and the left subclavian vein, so it can potentially be damaged during cannulation

This is not the case on the right side because the thoracic duct typycally drains into the venous system at the level of the subclavian vein; so the risk of injury is lower

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What are advantages of Subclavian Vein cannulation for CVP?

A

Easy accessibility

Good landmarks

Stability of catheter for long-term use

Easy to maintain sterility because it is farther away from pt’s nasal and oral secretions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What are disadvantages of Subclavian Vein cannulation for CVP?

A

High rate pneumothorax

Hemothorax

Pleural effusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

If attempt of cannulation of subclavian vein is unsuccessful on one side, attempt on contralateral side is contraindicated w/o first obtaining CXR. Why is that?

A

Because you do not want to cause bilateral pneumothorax

22
Q

CENTRAL VENOUS PRESSURE - SITES OF CANNULATION

What should you be aware of regarding holding pressure if the cannula accidentaly enters the arterial circulation during subclavian vein cannulation?

A

Holding pressure will be more demanding

It’s much more difficult to hold pressure on the chest than it would be on the neck

23
Q

CVP - SITES OF CANNULATION - External jugular vein

What are advantages of the EJ site for CVP cannulation?

A

Superficial and safe access (pt on heparin)

Both right and left are good options

24
Q

CVP - SITES OF CANNULATION - External jugular vein

Why is the EJ vein not an ideal site for CVP cannulation?

A

Tortious nature

Lower success rate

Kinks at SC vein

Enters the SC vein at a steep angle

25
Q

CVP - SITES OF CANNULATION - Antecubital vein

What are Advantages of the Antecubital vein when used as a CVP cannulation site?

A

Few complications

Typical location for PIC line placement

26
Q

CVP - SITES OF CANNULATION - Antecubital vein

Which controversy surround CVP values when measured at the AC site?

A

Some studies suggest that CVP is higher when measured from an AC line, but this is not clinically significant

27
Q

CVP - SITES OF CANNULATION - Antecubital vein

What are Disadvantages of the Antecubital vein when used as a CVP cannulation site?

A

Lowest success rate

Thrombosis

Thrombophlebitis

28
Q

CVP - SITES OF CANNULATION - Femoral vein

What are Advantages of the Femoral vein when used as a CVP cannulation site?

A

High success rate

Easy landmarks

Large diameter

29
Q

CVP - SITES OF CANNULATION - Femoral vein

What are disadvantages of the Femoral vein when used as a CVP cannulation site?

A

Catheter sepsis

Thrombophlebitis

Patients are unable to ambulate

30
Q

CVP - SITES OF CANNULATION - Femoral vein

Why is the Femoral vein typically not an ideal site for more than 24 hrs?

A

Increased risk for infections

This also applies to the femoral areterial line

31
Q

CVP - SITES OF CANNULATION - Femoral vein

Why should the Femoral line be inserted below the level of the inguinal line?

A

To decrease the risk of injury to the inguinal liguament

32
Q

CVP - SITES OF CANNULATION - Femoral vein

What’s a difficulty with obtaining CVP measurements from a femoral line?

A

Will require a longer catheter line that resides in the IVC

33
Q

CENTRAL VENOUS PRESSURE

WHERE SHOULD DISTAL ORIFICE OF any CVP CATHETER BE POSITIONED?

A

Insertion catheter (7.5 or 9 Fr.) into venous circulation and advancing until distal orifice positioned adjacent or within RA

34
Q

CENTRAL VENOUS PRESSURE

WHERE SHOULD DISTAL ORIFICE OF CATHETER BE POSITIONED to Guide fluid management?

A

Tip positioned within either RA or vena cava near caval-atrial junction

35
Q

CENTRAL VENOUS PRESSURE

For monitoring CVP waveform, why should the tip of the catheter BE POSITIONED within the atrium?

A

To accurately reflect pressure changes in RA

The waveform will not be dampened

36
Q

CENTRAL VENOUS PRESSURE

WHERE SHOULD DISTAL ORIFICE OF CATHETER BE POSITIONED for Aspiration of air emboli?

A

Tip (prefer multiport) in RA near SVC-atrial junction

This is because air emboli will flow pass this point and accumulate in the superior aspect of the junction

And this will allow for optimal aspiration

37
Q

INTERPRETING CVP WAVEFORM

CVP Waveform consists of five phasic events, which are?

A

Three ascents (a, c, v)

Two descents (x, y)

38
Q

INTERPRETING CVP WAVEFORM - 3 Ascent Waves

What does the a wave represent?

A

Right atrial contraction

This is the highest pressure wave on the curve

Occurs at end-diatole

Follows P wave on EKG

39
Q

INTERPRETING CVP WAVEFORM - 3 Ascent Waves

A large a wave could be indicative of which conditions?

A

Tricuspid stenosis

Pulmonary HTN

↓ RV compliance

40
Q

INTERPRETING CVP WAVEFORM - 3 Ascent Waves

What does the c wave represent?

A

Isovolumetric ventricular contraction

This is the second ascent wave or the next highest wave on curve

Occurs as a result of the Bulging of closed tricuspid valve into RA during early phase of RV contraction as a consequence of Isovolumetric ventricular contraction

Occurs in conjunction with QRS wave

Always follows the EKG R-wave

41
Q

INTERPRETING CVP WAVEFORM - 3 Ascent Waves

What does the v wave represent?

A

Right atrial filling

Occurs during late in ventricular systole while the Tricupsid valve is still closed and the atrium is filling

Occurs as a result of increase in RAP while atrium fills against a closed tricuspid valve

Peaks just after the EKG T-wave

42
Q

INTERPRETING CVP WAVEFORM - 3 Ascent Waves

Large v waves could be indicative of which conditions?

A

Tricuspid regurgitation

RV papillary muscle ischemia

RV failure

Constrictive pericarditis

Cardiac tamponade

43
Q

INTERPRETING CVP WAVEFORM - 2 Descent Waves

What does the x wave represent?

A

Systolic collapse of RA pressure

Occurs while the Tricupsid is pulling away in the RV during ventricular ejection

Tricuspid valve pulled downward at end of ventricular systole

44
Q

INTERPRETING CVP WAVEFORM - 2 Descent Waves

What does the y wave represent?

A

Diastolic collapse of RA pressures

Occurs when Tricuspid valve opens & RA empties passively into ventricle

45
Q

INTERPRETING CVP WAVEFORM

A

(Listen to slide 52)

No audio

46
Q

INTERPRETING CVP WAVEFORM

A

(listen to slide 52)

No Audio

47
Q

INTERPRETING CVP WAVEFORM

In some pathologic conditions, the a, c & v waves can change dramatically. In A-fib and A-flutter there will be no a-waves any longer, why?

A

The RA is quivering and not contracting

48
Q

INTERPRETING CVP WAVEFORM

Nodal rhythms, heart blocks and certain arrythmias will develop large a-waves or “canon-waves”, why?

A

The RA is contracting against a closed Tricupsid valve

49
Q

INTERPRETING CVP WAVEFORM

Tricupsid stenosis or RV failure will also have the “canon-wave”, why?

A

The RA is contracting against a stenotic valve

50
Q

INTERPRETING CVP WAVEFORM

In Tricupsid regurg, the c-wave and v-wave are fused, and the normal x-descent will disappear, why?

A

Effect of the regurgitant flow

8361 Exam I (18 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions