Module 7 Hemodynamics Flashcards
Hemodynamic
- the physical characteristics of actively circulating blood in the vascular system.
- these facts include blood flow rate (cardiac output), blood pressures, and vascular resistance.
What factors determine Hemodynamic Characteristics?
- Cardiac contractility
- Blood volume
- vascular smooth muscle tone
Why do we take clinical hemodynamic measurements?
- They are valuable in the assessment of cardiovascular function and adequacy of intravascular fluid volume.
- Also valuable in the monitoring and evaluation of the effects of various therapeutic interventions such as drug therapy and intravenous fluid therapy
Why do we use a pulmonary artery catheter, and what is another name for it?
- used to measure hemodynamic variables.
- often referred to as the Swan-Ganz Catheter.
How and where is the pulmonary artery catheter inserted?
- It is inserted into the heart and pulmonary vessels by way of the internal jugular vein.
- This vein provides a direct path to the right atrium.
- Other insertion sites include the subclavian vein, the femoral vein, and the basilic or median cubital veins in the right arm
Percutaneous Catheterization
The process of surgically puncturing the skin to gain vascular access to insert the catherter.
When the catheter is properly placed, what do the proximal and distal port communicate with?
- The proximal port communicates with the right atrium through the proximal lumen
- the distal port communicates with a small branch of the pulmonary artery through the distal lumen at the catheters tip.
Another definition of hemodynamics
The study of the forces (pressures) that influence the circulation of the blood.
PCWP
What does this stand for?
What is it?
- Pulmonary capillary wedge pressure
- The catheter has gained vascular acces, it is introduced into the vein with the balloon deflated; at that time a syringe is used to aspirate a small amount of blood from the catheters dital lumen, which is then flushed gently back with a small amount of saline solution. This makes sure the distal lumen is open.
- when the catheter tip enters the thoracic vein, the balloon is inflated to its recommended volume. ; at this volume the balloon protrudes slightly beyond the hard catheter tip, cushioning but not covering the distal opening. This allows cushioning and protection of the endothelium and endocardium. as well as allowing the blood to float the catheter tip through the heart to its proper position in the pulmonary artery.
- when the balloon tipped catheter wedges in a small pulmonary arteriole, it blocks blood flow between the catheters distal lumen and the left atrium.
- because blood flow is stopped, the BP measured through the distal lumen is about the same as the left atrial pressure. this is called the pulmonary capillary wedge pressure
How do we get the measurements of the pressures from the catheter?
- The proximal and distal catheter lumens are connected to pressure transducers, mechanical devices that convert pressure fluctuations to electrical signals.
- the electrical signals are displayed as pressure waveforms on a monitoring screen; pressure is displayed in the vertical axis and time on the horizontal axis.
How do waveform shapes aid in catheter insetion into the heart and pulmonary artery?
- they give information about the catheter tips location
CO
How is it measured?
- Cardiac output
- It is directly measured from pulmonary and systemic arterial catheters
- directly measured with the pulmonary artery catheter using the thermodilution technique
CVP
Central Venous pressure
PAP
Peripheral Arterial Pressure
PAWP
What Does it measure?
- Pulmonary Artery Wedge Pressure
- It measures pressures generated by the LEFT VENTRICLE
- it is used to assess left ventricular function
PVR
Pulmonary vascular resistance
SVR
What is it?
How is it determined?
- Systemic Vacular resistance
- primarily determined by vessel diameter and distensibility (compliance)
- SVR= (MAP-CVP)x 80/ Cardiac output
MAP
Mean Arterial Pressure
The amount of arterial pressure that is necessary to maintain adequate perfusion of vital organs, it is calculated by
Systolic BP+2(diastolic BP) divided by 3
What are the three main routes used to collect the pressures that influence the circulation of the blood, ie. the BP, CVP, PAP, PAWP, CO, PVR, SVR…
- Arterial lines- for info about the systemic system and perfusion
- Central Lines - for information about fluid balance and function of the right heart
- Pulmonary artery lines - for info about the pulmonary system, fluid balance, and the function of the left heart.
What is Pascal’s principle and how does it apply to hemodynamics?
- A change in pressure applied to an enclosed fluid is transmitted undiminished to every portion of the fluid and to the walls of the containing vessel.
- Application: When monitoring arterial blood pressure with a transducer connected to an arterial catheter via fluid filled pressure tubing… any changes in the arterial blood pressure are transmitted throughout the fluid filled line and are recorded by the transducer.
Ohm’s Law
Electrical:
Fluids:
- Electrical: Voltage=current x resistance
- Fluids: Pressure=flow x resistance
- Change in Pressure=Flow x Resistance
- Change in pressure is the driving pressure
- therefore,
- Resistance = change in pressure/Flow
What is an arterial line?
Where does it go?
What does it do?
- A thin catheter inserted into an artery.** **
- Most commonly the RADIAL ARTERY. But it can also be inserted into the BRACHIAL artery, or the FEMORAL artery. It should be placed where there is collateral circulation to the area.
- It monitors blood pressure real time. Rather than intermittent.
What are the three main routes used to collect data on BP, CVP, PAP, PAWP…CO, PVR, SVR…
- Arterial Lines
- Central Lines
- Pulmonary Artery Lines
What Information do we get from an Arterial Line?
Info about the systemic system and perfusion.