Hemodynamic monitors and equipment 2

Question 1

What is the approximate distance from the vena cava/right atrial junction to the right atrium?

Answer 1

0-10 cm

Question 2

What is the approximate distance from the vena cava/right atrial junction to the right venticle?

Answer 2

10-15 cm

Question 3

What is the approximate distance from the vena cava/right atrial junction to the pulmonary artery?

Answer 3

15-30 cm

Question 4

What is the approximate distance from the vena cava/right atrial junction to the PAOP position?

Answer 4

25-35 cm

Question 5

The CVP waveform reflects

Answer 5

the pressure inside the right atrium

Question 6

The CVP waveform has ____________ peaks and ______ troughs

Answer 6

three peaks (A, c, v) and two troughs (x, y)

Question 7

The A wave is equivalent to the

Answer 7

RA contraction

Question 8

The C wave is equivalent to the

Answer 8

tricuspid valve elevation into the RA

Question 9

The X decent is equivalent to the

Answer 9

downward movement of the contracting RV

Question 10

The V wave is equivalent to the

Answer 10

passive filling of the RA

Question 11

The CVP waveform is a reflection of the

Answer 11

pressure inside the right atrium

Question 12

What is the electrical event associated with the A wave of the CVP waveform?

Answer 12

just after P wave (atrial depolarization)

Question 13

What is the electrical event associated with the C wave of the CVP waveform?

Answer 13

Just after QRS complex (ventricular depolarization)

Question 14

What is the electrical event associated with the X descent of the CVP waveform?

Answer 14

ST segment

Question 15

What is the electrical event associated with the V wave of the CVP waveform?

Answer 15

Just after T wave begins (ventricular depolarization)

Question 16

What is the electrical event associated with the Y descent of the CVP waveform?

Answer 16

after T wave ends

Question 17

Central venous pressure is:
a. falsely increased by placing the transducer above the zero point
b. increased by PEEP
c. decreased by pericardial tamponade
d. unchanged by a ventricular septal defect

Answer 17

b. increased by PEEP

Question 18

The CVP should be zeroed at the

Answer 18

fourth ICS at the mid anteroposterior level (phlebostatic axis)

Question 19

The CVP measurement is best taken at

Answer 19

the end-expiration

Question 20

The normal CVP in the adult is

Answer 20

1-10 mmHg

Question 21

The CVP is not a great monitor of

Answer 21

real-time intravascular volume assessment

Question 22

Factors that increase CVP include

Answer 22

hypervolemia
tricuspid stenosis or regurgitation
pulmonary hypertension
cardiac tamponade
PEEP
VSD
constrictive pericarditis
pulmonic stenosis
RV failure

Question 23

A low CVP is almost always caused by

Answer 23

hypovolemia or if the transducer is moved above the zero point

Question 24

A CVP transducer placed above the zero point will

Answer 24

underestimate CVP

Question 25

Central venous pressure is a function of

Answer 25

intravascular volume
venous tone
right ventricular compliance

Question 26

Which conditions increase the amplitude of the a wave on the CVP waveform? (select 2)
a. tricuspid stenosis
b. atrial fibrillation
c. diastolic dysfunction
d. tricuspid regurgitation

Answer 26

a. tricuspid stenosis
c. diastolic dysfunction

Question 27

Select causes of a missing a wave include

Answer 27

atrial fibrillation & V-pacing if the underlying rhythm is asystole

Question 28

Select causes of a large a wave include

Answer 28

tricuspid stenosis, diastolic dysfunction, myocardial ischemia, chronic lung disease leading to RV hypertrophy, junctional rhythm, PVCs, & AV dissociation

Question 29

Select causes of a large v wave include

Answer 29

tricuspid regurgitation, acute increase in intravascular volume, & RV papillary muscle ischemia

Question 30

The diastolic pressure __________ as the tip of the PAC catheter moves beyond the pulmonic valve

Answer 30

rises

Question 31

______________- is formed during pulmonic valve closure during diastole with a PAC.

Answer 31

The dicrotic notch

Question 32

The pulmonary artery occlusion pressure is an estimate of

Answer 32

left ventricular end diastolic pressure

Question 33

When the PAC is in the right ventricle, the waveform changes in the following ways:

Answer 33

the systolic pressure increases
the diastolic pressure is equal to CVP

Question 34

The waveform of the pulmonary artery occlusion pressure (wedge pressure) is akin to the

Answer 34

CVP of the left heart

Question 35

The a wave of the pulmonary artery occlusion pressure is caused by

Answer 35

left atrial systole

Question 36

The c wave of the pulmonary artery occlusion pressure is caused by

Answer 36

mitral valve elevation into the LA during LV systole

Question 37

The v wave of the pulmonary artery occlusion pressure is caused by

Answer 37

passive left atrial filling

Question 38

Normal systolic right ventricular pressure is

Answer 38

15-30 mmHg

Question 39

Normal diastolic right ventricular pressure is

Answer 39

0-8 mmHg

Question 40

Normal systolic pulmonary artery pressure is

Answer 40

15-30 mmHg

Question 41

Normal diastolic pulmonary artery pressure is

Answer 41

5-15 mmHg

Question 42

Normal pulmonary artery occlusion pressure is

Answer 42

5-15 mmHg

Question 43

In which lung zone should the tip of the pulmonary artery catheter be placed?

Answer 43

zone 3

Question 44

Zone 3 is the _______ region of the lung

Answer 44

dependent

Question 45

Things that suggest that the tip of the PA catheter is NOT in zone 3 include:

Answer 45

PAOP>pulmonary artery end-diastolic pressure
non-phasic PAOP tracing
inability to aspirate blood from the distal port when the balloon is in the wedged position

Question 46

Why should the tip of the PA catheter be positioned in zone 3?

Answer 46

continuous column of blood between the tip of the PAC and the left ventricle (LVEDP reflects back through the pulmonary circulation)