VALLEY: ECG/CVP/PAP/BP Monitoring Flashcards
What is Einthoven’s triangle?
Einthoven’s triangle is a representation of the placement of the three standard limb leads.
Where are the leads placed for lead I?
left arm positive, right arm negative, left leg ground
Where are the leads placed for Lead II?
right arm negative, left leg positive, left arm ground;
Where are the leads placed for Lead III?
left arm negative, left leg positive, right arm ground.
Where are the leads placed for lead VS?
The positive electrode for lead VS is placed between the middavicular line and the lateral chest line in the 5th. intercostal space. The negative electrode is placed on the left or right arm.
What two monitors detect cardiac dysrhythmias?
(1) Stethoscope
(2) electrocardiogram
List five reasons for using the electrocardiogram?
(1) Detect cardiac dysrhythmias (leads I or II).
(2) detect myocardial ischemia,
(3) detect electrolyte abnormalities
(4) calculate heart rate
(5) detect pacemaker malfunction.
The ECG is recorded on ruled paper. What is the size of the smallest square? Each small division on an ECG tracing, when measured horizontally between the fine lines, represents how many seconds?
The smallest unit is l mm tall by 1 mm wide.Each mm corresponds to 0.04 seconds.
How many millivolts (mV) are generated on the skin by electrocardiographic (ECG) signals? How many microvolts
(V) is this?
ECG potentials on the skin are on the order of l millivolt ( m V) , which is l,000 microvolts
Is currently the standard for monitoring patients with suspected myocardial ischemia
A 5-cable (5-lead) ECG monitoring In the five-electrode (S-cable) monitoring system, the four limb electrodes, LA, RA,
LL, and RL placed at their corresponding monitoring locations allow any of the six bipolar limb leads (I, II, III, aVR, aVL, and a VF) to be obtained, and a fifth chest electrode can be placed in any of the standard
precordial V 1 to V6. locations.
Describe the proper placement of RA, LA,
Proper placement of the RA electrode is over the outer right clavicle and of the LA electrode is over the outer left clavicle..
The LL electrode is placed near the
left iliac crest or midway between the costal margin and left iliac crest along the anterior axillary line.
The RL electrode may be placed at any
convenient location on the body
Which unipolar lead in the S-lea monitoring system is preferred when arrhythmias are anticipated?
In the 5-lead system, VI is preferred for special arrhythmia monitoring
Which unipolar leads are preferred for monitoring ischemia?
V3 to V5 are the preferred leads for monitoring ischemia
List six indications for using a central venous catheter?
- to measure central venous venous pressure
- for rapid infusion of fluids,
(3) for transvenous pacemaker insertion
(4) for parenteral alimentation
(5) for chemotherapy, (
6) to remove air if there is a high risk for venous air embolism
What jugular vein, right or left, is most often preferred for cannulation for CVP? why?
The right internal jugular is preferred because of its straight course to the SVC.
Where is the thoracic duct?
Left IJ
3 risk for LJ vein for CVC
- Vascular erosion
- Pleural effusions
- PUNCTURE OF THORACIC DUCT
Where should the tip of the CVC be located?
Just above the junction of the Superior vena cava and the Right atrium
When the central venous pressure (CVP)line is inserted via the right internal jugular, the tip of the catheter on x-ray will be seen at the level of what thoracic vertebra?
Radiography will show the catheter tip positioned below the inferior border of the clavicles and above the T4 to T5 interspace.
Why should the zero point of the manometer or transducer be positioned exactly for measurement of central venous pressure?
So low venous pressures are to be measured accurately and reproducibly.
The a wave is the result of
right atrial contraction
The c wave is caused by a
slight elevation of the tricuspid valve into the right atrium during ventricular contraction
The v wave is due to
blood flow into the right atrium before the tricuspid valve opens.
Think about a central venous pressure (CVP} waveform: What do x-descent and y-descent indicate?
x-descent occur during ventricular systole and represents atrial relaxation with downward displacement of the tricuspid valve.
Think about a central venous pressure (CVP} waveform: What do y-descent indicate?
The y-descent occurs during diastole and represent early ventricular filling through the open tricuspid valve.
What is the normal CVP reading
0-11 mmHg
What are four early signs of increased central venous pressure?
(l) distended peripheral veins,
(2) increased right heart filling pressures
(3) increased heart rate
(4) bounding peripheral pulses
What are three late signs of increased central venous
pressure?
(1) systemic edema,
(2) S-3 gallop
(3} decreased pulmonary compliance.
What three pathological conditions may cause an elevated central venous pressure (CVP) to occur?
Pulmonary hypertension, right heart failure, or left heart failure.
What two situations would cause the CVP reading be higher than the PCWP?
presence of: (l) right ventricular failure, possibly secondary to pulmonary hypertension, or (2) pulmonary embolus
What is the most common complication of central venous cannulation?
Infection.
What is the incidence of pneumothorax during subclavian vein cannulation?
1%.
What confirms entry of the catheter into the internal jugular vein?
Return of desaturated venous blood
What five sites are acceptable for inserting a pulmonary catheter?
( l) right internal jugular; (2) external jugular;
(3) subclavian; (4) antecubital- preferably basilic, and (5) femoral veins.
What site should not be used for insertion of a pulmonary artery catheter?
Left internal jugular
With right internal jugular insertion of a pulmonary artery (Swan-Ganz} catheter, what is the distance to the right atrium and pressure transduced there? right ventricle, pulmonary artery, and the wedge position? What pressures will you normally see when the tip of the catheter is at each of these locations?
Right atrium: 18-22 cm and 6-8 mm-Hg;
With right internal jugular insertion of a pulmonary artery (Swan-Ganz} catheter, what is the distance to the right Ventricle and pressure transduced there?
right ventricle: 28- 32 cm and 25/0 mm-Hg;
With right internal jugular insertion of a pulmonary artery (Swan-Ganz} catheter, what is the distance to the pulmonary artery and pressure transduced there?
pulmonary artery: 40- 50 cm and 25/12 mm-Hg;
With right internal jugular insertion of a pulmonary artery (Swan-Ganz} catheter, what is the distance to the pulmonary WEDGE and pressure transduced there?
pulmonary wedge: 45- 50 cm and 2-12 mm-Hg
Specify six indications for a pulmonary artery catheter.
(1) patients with known cardiovascular disease;
(2) cross clamping of the thoracic aorta is anticipated;
(3) respiratory failure;
(4) suspected or diagnosed pulmonary emboli
(5) pts w/previous cardiac surgery
6) when pneumonectomy
You listed six indications for a pulmonary artery catheter previously. State six more indications.
Sepsis Significant fluid shifts pulmonary HTN, or PVR Cor pulmonale Treated with bleomycin Continuous inotropes and vasodilators.
Give three (3) contraindications to use of a pulmonary artery catheter.
Relative contraindications
( l) complete left bundle branch block,
2) Wolff-Parkinson-White syndrome
(3) Ebstein’s malformation
What ejection fraction and cardiac index are suggestive of poor left ventricular function and hence an indication for a
pulmonary artery catheter?
Ejection fraction <0.4; cardiac index <2. l \/min
What is the most severe complication of a pulmonary artery catheter?
Pulmonary artery perforation and hemorrhage
What three actions should be taken to treat pulmonary artery perforation and hemorrhage?
(l) Replace volume, (
2) use positive end-expiratory pressure, and (
3) isolate involved lung with a double-lumen tube or advance a single lumen tube into the nonhemorrhaging lung
What is the most common complication with the insertion of a Swan·Ganz catheter?
Arrhythmias as the catheter goes through the right ventricle
What drug is used to treat arrhythmias that occur during the placement of a Swan-Ganz catheter?
Lidocaine.
What is the most commonly used size of a swan-Ganz catheter?
7Fr
What are two causes of a Swan-Ganz catheter not reaching the pulmonary artery?
- Perforation
2. Coiling