Monitoring Final Flashcards
2 Basic Modes of US for vascular access
Doppler and B-mode
Doppler US
audible sound
- arteries and veins sound different
B-Mode US
2D mode
Generates a 2D picture in a gray scale that is applied based on the amplitude of the signal
- B stands for brightness
B-Mode US appearance
fluid filled = black or dark grey
soft tissue (muscle) = gray
Solid structures
Technical Tricks for IV access
T-berg and valsalva manuever
Controls to know on US machine
- gain adjust
- depth
- freeze
- contrast/brightness
4 manuevers for a good US image
- pressure
- alignment
- rotation
- tilting
Color Doppler
represent the direction of low relative to transducer
- Red: flow towards transducer
- Red does not always mean artery
When is a provider considered competent in CVC placement
after 50 times
US guidance for regional usually uses what probes?
linear probes and dynamic (B-mode) setting
Different frequencies for regional anesthesia
Higher frequency for superficial (upper extremity) blocks
Lower frequency needed for deeper blocks (infraclavicular, femoral)
CFNB
continuous femoral nerve block
US vs. nerve stimulator
US has decreased time to placement and no conversion to general anesthesia
What does an implantable pacemaker treat?
bradycardia and conduction abnormalities
What does AICD treat?
SVT and fibrillation
What battery is commonly used in a pacemaker?
lithium-iodide
How long does a pacemaker/AICD usually last?
5-8 years
- output voltage decreases gradually
- sudden battery failure unlikely
Pacemaker lead system
- endocardial leads placed via central access
- fix on the endocardium
Endocardial Leads
active fixation: metal scews
passive fixation: rubber fins or tines
Epicardial Leads
screw-in or sew-on
Polarity of pacing leads
unipolar - highest reliability
bipolar - improved rejection for better sensing
multipolar - special purpose leads
Types of lead tip of pacing leads
- steroid eluting
- non-steroid eluting
- carbon
Synchronous Pacemaker (basics)
- Demand mode
- Sensing circuit searches for intrinsic depolarization potential
- If absent, a pacing response is generated
- Can mimic intrinsic electrical activity pattern of the heart
Anti-tachycardic functions are only used in which type of pacer?
AICDs