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Adult Critical Care > Test 5 > Flashcards

Test 5 Flashcards

hemodynamics

1
Q

Indications for Arterial line

A
  1. Continuous blood pressure monitoring (Right radial artery
  2. Pt who needs frequent ABGs
  3. Able to draw blood samples for lab
  4. Can titrate drugs, give immediate response (appropriate drug/ fluids response, Vassopressors/ dilators
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2
Q

Gold standard BP

A

noninvasive BP. Comes from aorta (L.heart)

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3
Q

Can you give meds through arterial line?

A

no.. against flow (cardiac and systemic)

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4
Q

Arterial line insertion sites

A 
only catheter going against stream
1. Radial (most common): easy access
2. Brachial
3. Femoral
RISK CAN BLEED OUT EVERY BEAT
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5
Q

Transducer

A

Gives waveform, zeroing the CVP line- automatic flushing system, keep level with rt atrium (heart).
Pressure keeps blood in body.
Transducer raised= Lower number/ pressure
Lower transducer = Higher numbers/ pressure

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6
Q

Pressure bag

A

Contains normal saline: cant contain air -> be above systolic pressure, above 300mmhg. Pressure keeps blood in body

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7
Q

Dicrotic notch on waveform

A

when aortic valve closes

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8
Q

Arterial pressure waveforms

A

Should have a clear upstroke on the left with a dicrotic notch representing aortic valve closure on the descending side of the waveform,

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9
Q

If dicrotic notch is not visible, the pressure tracing

A

is dampened and is probably inaccurate

-Your blood pressure reading will read higher or lower. you can use it to trend with noninvasivve blood pressure

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10
Q

Complications from arterial line

A

-Ischemia: Embolism, thrombus, arterial spasm
Prevented by irrigating with diluted heparin solution
-Hemorrhage: if arterial line becomes disconnected
-Infection: incidence increases over time

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11
Q

Types of Centrally located catheter lines: Central Venous lines

A

PICC (pick)-ICU pts
Porta Catheter-Chemo pts
Swan-Ganz- Cardiogenic shock pts
Tunneled catheter- Long term use

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12
Q

PICC

A

ICU pts
Peripherally inserted central (venous) catheter, brachial vein far from heart
-More stable invasive line

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13
Q

Porta Catheter

A

under the skin port, commonly used to administer chemotherapy. Nothing exposed (disk)
-Can cause heart damage

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14
Q

Swan-Ganz

A

Cardiogenic shock pts
Flow directed pulmonary artery catheters.
-Most invasive, used cautiously

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15
Q

Tunneled Catheter

A

catheter is tunneled under the skin reducing the risk of infection
Under the skin before getting to blood supply, far from heart
-Ex: Groshong, Hickman, Broviac=Common brand names

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16
Q

Lumen

A

How many things can connect to central line

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17
Q

mixed venous sample

A

only venous, mixed with blood from head and toes together

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18
Q

PICC is less likely for

A

pneumothorax (unlike subclavian)- atrogenic (med. caused)

-more stable invasive line

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19
Q

CVP insertion sites

A 
Central Venous pressure
-Subclavian Vein
-Internal Jugular Vein
-Femoral Vein
=risk of causing pneumothorax
-Connect to septic shock, Provide fluid (guide fluid)
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20
Q

Common CVP catheter size

A

Most common: Size 7 french

-3 lumens

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21
Q

Indications for monitoring CVP

A

-Monitor circulating blood volume
-Monitor venous return (should increase)
-Monitor rt ventricular pressures
pts with:
-Trauma with major blood loss
-Severe dehydration
-Pulmonary edema, to guide fluid therapy
-Right sided myocardial infarction

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22
Q

Arterial Stenosis

A

Narrowing of tricuspid= increase CVP

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23
Q

Central venous line should be placed when

A
  1. Pt has hypotension and is not responding to fluid resuscitation
  2. Continued hypovolemia secondary to fluid shifts or continued fluid loss
  3. Pt requires inotropes and or vasopressors
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24
Q

Benefits of having a CVP line

A

Rapid infusion of meds or fluids
You can draw blood for labs
Three different ports allow for both meds to be delivered, blood to be drawn, and injections for CO measurement

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25
Q

How is CVP measured

A

Transducer

Water Manometer

26
Q

CVP pressure

A

of the blood in the vena cava, right atrium, and right ventricle during diastole

27
Q

CVP Measures, and reflects

A

right heart function and reflects:

  • Preload and end diastolic filling pressure
  • Ability of the right heart to pump blood into the pulmonary system into the left side of the heart
28
Q

Increase in CVP

A
  1. Increased venous return
  2. Increased Intra-thoracic pressure
  3. Decreased ability of the right heart to move blood
29
Q

Decrease in CVP

A
  1. Decreased venous return
  2. Decreased intra-thoracic pressure
  3. Increased ability of the heart to move blood forward
30
Q

Respiration and CVP

A
  • CVP decreases with inspiration (neg pressure)
  • CVP increases with positive pressure vent
  • CVP increases with PEEP
  • Respiratory factors skew CVP readings
  • CVP are used to trend
31
Q

Complications of invasive central lines

A 
Infection (can run labs on line)
Bleeding
Pneumothorax
Air Embolus
Development of a clot around the catheter: check perfusions of hand (nail bed)
32
Q

Swan Ganz, measurements obtainable

A

Balloon tipped flow directed catheter

  1. CVP: rt heart, venous return
  2. PAP: lung
  3. PCWP/PAOP: left heart
33
Q

what can the swan ganz/ PA catheter do

A
  • Pace heart: temp internal pacing
  • Measure CO
  • Measure PCWP
  • Measure CVP
  • Measure PA

=While placing swan: Possible disrythmias

34
Q

Risk with balloon inflation

A

pulmonary infaction

35
Q

Measure SV

A

Echo

36
Q

Who gets a Swan-Ganz catheter

A
  • Benefits outweigh the risks
  • Recent studies (20years worth) suggest no significant change in improvement or mortality of pts
  • must be individualized
37
Q

Risks of Swan-Ganz catheter

A
  • Invasion of the catheter may cause dysrhythmias
  • Chance of pulmonary infarction with balloon occlusion
  • Air embolism
38
Q

Critical conditions where PA catheters are considered

A
  • Severe cardiogenic pulmonary edema, unstable angina, ventricular pathology
  • ARDS pts who are hemodynamically unstable
  • Major coronary bypass surgery with MI and poor ventricular function
  • Pts with cardiogenic (fix pump) or septic shock (fix underlying cause)
39
Q

Placement of PA catheter

A

When it reaches the superior vena cava or the rt atrium the balloon is inflated

  • waveforms change as it advances into the pulmonary artery
  • Eventually a wedge pressure will be obtained
40
Q

Wedge

A

occurs when the balloon drifts into the PA that is too small to allow further advancement of the catheter

41
Q

Most common cause of an increase in PCWP is

A

left heart failure

42
Q

Systolic heart failure

A

Heart muscle isnt strong enough to pump blood

43
Q

Diastolic heart failure

A

Heart cant relax

44
Q

Both systolic and diastolic heart failures

A

Decrease in CO

45
Q

Hemodynamic medications

A

Inotropes: Contraction
Chronotropes: Time, increase or decrease HR
-ex atropine: increase HR, Beta blockers Decrease HR
Dromotropic Effect: conduction
-Speed of conduction, Amiodorone

46
Q

Pressors-Dilators

A

-Systemic Purpose: Norepinephrine
Septic shock, circ issues
-Pulmonary Purpose: Veletri-Pulm dilators
ARDS, Pulm hypertension
-Coronary Purpose: Nitroglycerine Coronary Vassodilators
Angina

47
Q

Blood flow [right side of heart]: diastole

A

Blow flows into the atria and ventricle [85% of blood in the heart is received)

  • tricuspid valve remains open
  • ventricle is in a relaxed state (pressure below that of vena cava)
48
Q

Atrial contraction

A

Sa mode causes atrial contraction filling the ventricles another 10-30% ( increases the volume of blood into the ventricles)

49
Q

Transition

A

Tricuspid valve closes (lub) when the ventricular pressure exceeds that of the attia

50
Q

Normal systemic BP, pulmonary, MAP

A 
Systemic= 120/80
Pulmonary= 25/8
MAP= sBP + (2xdBP) / 3, keep above 60
51
Q

Normal average PAP

A

13.67

52
Q

Cardiac output

A

CO= Hr x av

Normal 4-8, athlete can have up to 35 lpm

53
Q

Why do we worry about left side heart

A

Provides blood flow/ pulse to body
Satisfies the bodies o2 demand
Removes waste
Transports hormones and nutrients

54
Q

Cardiac index

A

Varies with body size

CI= CO/ BsA

55
Q

Body surface area

A

Calc using pts weight and height
Found on monogram
Norm2.5-4.0
Universal

56
Q

Venous Return

A

All the blood coming back to heart
Venous system holds 64% of total blood vol for emergencies
10 in arteries
75 in pulmonary capillary bed

57
Q

Stroke volume

A

Measure by echo or indirectly
Amount of blood ejected by left ventricle with each contraction
Norm 60-130
Composed of.. preload, contractility, afterloadMeasure by echo or indirectly
Amount of blood ejected by left ventricle with each contraction
Norm 60-130
Composed of.. preload, contractility, afterload

58
Q

Ventricular volume

A

End systolic volume and EDV

59
Q

ESV

A

Norm 50-60ml

Amount of blood in ventricle at the end of emptying

60
Q

EDV

A

amount of blood in the ventricle at the end of filling
Measure indirectly with end diastolic pressure
Norm 120-180

61
Q

Ejection fraction

A

Percent of the end diastolic vol that is rejected with each beat
Norm 50-70
?measure directly echo

Adult Critical Care (5 decks)

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