P&P - Arterial Line

Question 1

systemic arterial pressure waveform results from

Answer 1

ejection of blood from LV into aorta during systole

Question 2

Systolic waveform components

Answer 2

steep pressure upstroke
peak
decline

Question 3

Systolic waveform occurs when?

Answer 3

immediately following ECG R wave

Question 4

Systolic upstroke occurs when?

Answer 4

120-180 milliseconds after beginning R wave

Question 5

dicrotic notch represents what

Answer 5

aortic valve closure

Question 6

pressure transducer should remain

Answer 6

fixed at th elevel of the heart

Question 7

NBP in dependent arm

Answer 7

higher BP

Question 8

NBP in nondependent (up) arm

Answer 8

lower BP

Question 9

A-line flush rate

Answer 9

1-3 mL/hour

Question 10

Arterial pressure transducers should be placed to best estimate

Answer 10

aortic root pressure

Question 11

Preferred transducer location

Answer 11

5cm posterior to sternal border

Question 12

Underdampened pressure

Answer 12

systolic BP overshoot

Question 13

overdampened pressure

Answer 13

Falsely narrowed pulse pressure, MAP reliable, absent dicrotic notch

Question 14

Damping coefficient is too low

Answer 14

underdamped

elevated SBP

Question 15

Damping coefficient is too high

Answer 15

overdamped

decreased SBP

Question 16

Arterial waveform is produced by

Answer 16

summation of sine waves

Question 17

Which two waves are needed to produce arterial waveform?

Answer 17

fundamental wave

harmonic wave

Question 18

Negative Allens Test

Answer 18

palm remains pale >6-10 seconds

Question 19

Peripheral vs central waveforms

Answer 19

Higher SBP
Lower DBP
Wider Pulse pressures

Question 20

Waveform in Aortic Stenosis

Answer 20

Small in amplitude (pulsus parvus)
Slowly rising systolic upstroke
Delayed peak in systole (pulsus tardus)
Appears overdamped, anacrotic notch 
No discernible dicrotic notch

Question 21

Waveform in Aortic Regurgitation

Answer 21

Sharp increase
wide pulse pressure
bisferiens pulse (two systolic peaks)

Question 22

Waveform in Hypertrophic Cardiomyopathy

Answer 22

Bifid shape (“spike-and-dome”)

Question 23

Pulsus Alternans

Answer 23

Larger and smaller pulse pressures that alternate with respiratory cycle
Regular rhythm

Question 24

Pulsus Paradoxus

Answer 24

exaggeration of a normal variation in bp from spontaneous ventilation

Question 25

causes of Pulsus paradoxus

Answer 25

``` cardiac tamponade** pericardial constriction severe airway obstruction bronchospasm dyspnea ```

Question 26

SPV

Answer 26

Systolic Pressure Variation

Question 27

SPV is?

Answer 27

normal 7-10mmHg | Dependent on pressures in chest and timing of inspiration/expiration on mechanical ventilation

Question 28

Normal PPV

Answer 28

Pulse Pressure Variation | 13-17%

Question 29

The accuracy of an ABP waveform is determined by the _______ and ________ of the pressure monitoring system.

Answer 29

natural frequency | damping coefficient

Question 30

Because of _____, the ABP recorded from peripheral sites has a ______ pulse pressure than when measured more centrally.

Answer 30

wave reflection | wider

Question 31

Complications of NIBP

Answer 31

Pain Petechiae and ecchymoses Limb edema Venous stasis and thrombophlebitis Peripheral neuropathy Compartment syndrome

Question 32

Indications for IABP

Answer 32

Continuous, real-time blood pressure monitoring Planned pharmacologic or mechanical cardiovascular manipulation Repeated blood sampling Failure of indirect arterial blood pressure measurement

Question 33

established the zero reference point for the transducer system

Answer 33

Zeroing

Question 34

matches this reference point to a specific point on the patient’s body

Answer 34

Leveling | determines where the value 0 will be and, hence, from where measurements will begin

Question 35

Arterial pressure transducers should be placed to best estimate _________ pressure.

Answer 35

aortic root

Question 36

Results in underestimation of aortic pressure

Answer 36

Radial artery monitoring during hypothermic cardiopulmonary bypass Air in transducer tubing

Question 37

How will an arterial pressure transducer that is placed below the level of the heart affect the estimate of the actual blood pressure?

Answer 37

It will overestimate the actual blood pressure

Question 38

Which of the following will result in an overestimation of the actual blood pressure? A. Placing a blood pressure cuff too tightly B. Using a blood pressure cuff that is too large C. Placing the cuff on an extremity in which you have placed an intravenous line D. Placing a blood pressure cuff on an extremity that is below the level of the heart

Answer 38

D. Placing a blood pressure cuff on an extremity that is below the level of the heart

Question 39

The most significant expected alteration from a cracked stopcock in an arterial pressure monitoring system would be A. damping of the arterial waveform B. overestimation of the blood pressure C. air entrainment into the transducer tubing D. acute blood loss

Answer 39

D. acute blood loss

Question 40

Determines damping coefficient

Answer 40

High Pressure Flush

Question 41

High pressure flush results in 0 oscillations

Answer 41

Overdamped system

Question 42

High pressure flush results in 1 oscillation

Answer 42

Optimally damped system

Question 43

High pressure flush results in 1+ oscillations

Answer 43

Underdamped system