T1: Hemodynamic Monitoring Flashcards
what is end organ perfusion
the needed amount of blood and BP to perfuse a specific organ
what is the mean arterial pressure for the kidney
60 or above
what is the mean arterial pressure for the braain
80-100
what area of the hearts tells us about JVD
atrium
what does right arterial pressure tell us about a patient
the fluid status
the pulmonary artery will tell us
the pressure in the lungs
Central venous pressure (CVP)
pressure in the superior vena cava
Cardiac Output (CO)
volume of blood pumped by heart in 1 minute
Systemic and pulmonary arterial pressures
Pulmonary artery wedge pressure (PAWP/PAOP)
6-12mmHg
preload
Volume of blood within ventricle at end of diastole
afterload
Forces opposing ventricular ejection
Cardiac Index (CI)
CO adjusted for body surface area (BSA)
contractility
◦Strength of ventricular contraction
No direct clinical measures (can’t really measure until we get an echocardiogram
Stroke volume (SV)/stroke volume index (SVI)
The amount of blood pumped out of the heart with each contraction (heart beat)
Stroke volume variation (SVV)
measuring the percent increase in SV after a fluid bolus
O2 saturation of arterial blood (SaO2)
percentage of oxygen-saturated hemoglobin relative to total hemoglobin in the arterial blood
95-100%
Mixed venous O2 saturation (SvO2)
Determines adequacy of tissue oxygenation, status, response to treatment/activity
60-80%
where can Pulse oximetry (SpO2) be found
finger tip, toes, forehead, earlobe
Where should the transducer be placed for accurate measure of pressure?
plebostatic axis (basically armpit)
after the transducer is placed at the plebostatic axis what should be done
zero and calibrate it
Referencing
placing transducer so zero-reference point is at level of atria of heart or phlebostatic axis
what does the square wave test tell you
tells you if the equipment is working
how can we create waves with the square wave test
◦Flushing system creates wave
Too many spikes or whipping on square wave test
◦False HIGH reading
No spikes or whipping with gradual return to normal on square wave test
◦BLOCKAGE
when using invasive pressure monitoring, what should you never do
NEVER TURN A LINE OR VENTILATOR ALARMS OFF OR SILENCE IT
dicrotic notch
brief rise in aortic pressure as blood rebounds off closed valve
Central Venous Pressure (CVP) Monitoring measures
right ventricular preload that reflects fluid volume
Central Venous Pressure (CVP) Monitoring is obtained from
◦Central venous catheter
◦PICC line-open ended
◦PA (pulmonary artery) catheter
where must the tip of the catheter lie for CVP to be accurate
SVC (superior vena cava)
SvO2 and ScvO2 reflect..
balance among oxygenation of arterial blood, tissue perfusion, and tissue oxygen consumption
CVP measures
central venous oxygen saturation (ScvO2)
PA measures
mixed venous oxygen saturation (SvO2)
normal Systemic Venous Oxygen Saturation (SvO2)
60% to 80% at rest
Decreased in SvO2 or ScvO2 may indicate:
◦Decreased arterial oxygenation
◦Low CO
◦Low hemoglobin level
◦Increased oxygen consumption or extraction
PA Catheter Complications
-Infection and sepsis
-Air embolus (e.g., disconnection)
-Pulmonary infarction or PA rupture
-Ventricular dysrhythmias
PA Catheter Complications: Infection and sepsis intervention
◦Asepsis for insertion and maintenance
◦Change flush bag, pressure tubing, transducer, and stopcock every 96 hours
PA Catheter Complications: Air embolus intervention
◦Monitor for balloon integrity
◦Luer-Lok connections; alarms on
PA Catheter Complications: Pulmonary infarction or PA rupture intervention
◦Do not inflate balloon with more than 1.5 mL
◦Monitor waveforms continuously
◦Maintain continuous flush system
PA Catheter Complications: Ventricular dysrhythmias intervention
◦Monitor during insertion and removal
◦Also for migration of PA catheter
Nursing Management for Hemodynamics
◦General appearance
◦Level of consciousness
◦Skin color/temperature
◦Vital signs
◦Peripheral pulses
◦Capillary refill
◦Urine output
what is the purpose of Circulatory Assist Devices (CADs)
Decrease cardiac work and improve organ perfusion
Intraaortic Balloon Pump (IABP)
Provides temporary circulatory assistance by reducing afterload inserted in femoral artery
IABP Complications
1)Thrombus and embolus formation
2)Thrombocytopenia
3)Ischemia to periphery, kidneys, bowel
4)Infection
5)Mechanical malfunction
Ventricular Assist Devices (VADs) is for
Short- and long-term support for failing heart
Bridge while awaiting transplant
Ventricular Assist Devices (VADs) Shunts blood from
left atrium or ventricle to device, then to the aorta
Implantable Artificial Heart
Fully implantable device
Can sustain the body’s circulatory system
