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A&C II EXAM II > Hemodynamics > Flashcards

Hemodynamics Flashcards

1
Q

Hemodynamics is the name given to the ______ that control ______ through the body.
The end goal of hemodynamics is _____________.

A

forces, blood flow

adequate tissue perfusion

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2
Q

The body has ________________ that will change hemodynamic forces to compensate for ____________________.

A

compensatory mechanisms

inadequate tissue perfusion

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3
Q

When these compensatory mechanisms fail due to illness, we use _____________________ to identify and address problems to restore adequate blood flow to tissues.
heart rate increase is an example.
when youre sick (septic, buring through o2 demand) your compensatory mechanisms fail.
another way they are taken out is through heart surgery (bypass

A

hemodynamic monitoring,

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4
Q

END goal of hemodynamics: is the ______ being ________________?

A

tissue, adequately perfused

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5
Q

how do we monitor tissue perfusion?

A

(urine output, toes pink and warm)

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6
Q

Give the blood flow pathway through the circulatory system?

A

Inferior vena cava and superior vena cava

right atrium

tricuspid valve

right ventricle

pulmonic valve

pulmonary artery

lungs

pulmonary vein

left atrium

mitral valve

left ventricle

aortic valve

aorta

body

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7
Q

____________- Strong, elastic, three-layered vessels. Tough outer coating, middle smooth muscle layer, and smooth, slippery connective tissue that allows the blood to flow easily. ____________will dilate or constrict to meet metabolic demand.

A

Arteries

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8
Q

___________- microscopic vessels, one cell-layer thick walls allow for easy passage of gasses, nutrients, and hormones into and out of the blood.

A

Capillaries

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9
Q

__________- Weak, elastic, three-layered vessels. Low-pressure system. One-way valves help the__________ return blood back to the heart. 70% of all blood in the body is in the __________ system at any time.

A

Veins

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10
Q

how many liters of blood do we have normally? What are some variations?

A

5 L. smaller bodies have less and bigger bodies have more.

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11
Q

Vasopressors and vasodilators act on receptors in the ______________ layer of the arteries and veins to cause them to contract or expand = increasing or reducing the pressure. Remember: the body makes it’s own _________ to change the diameter of arteries and veins as well.

A

middle muscle (smooth layer), catecholamines

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12
Q

Heart failure arises when?

A

muscles or the valves start to fail (or malfunction).

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13
Q

Valve function is dependent on _____________ on the valves. they work well until ___________ or _________ valve.

A

pressures, stenosis, regurgitating

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14
Q

__________ phase of the cardiac cycle
when heart is at rest

A

Diastolic

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15
Q

_____________________ phase:

The heart is at rest
Blood flows into the right and left _________

The __________________ are open because the ______________________________ are the same when the heart is at rest.

A

Passive diastolic, atrium, tricuspid and mitral valves, pressures in the atria and ventricles

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16
Q

___________________ phase:

Electrical stimulation from the SA node sends a signal for the atria to contract (P wave on the ECG)
Atria squeeze blood into the ventricles
Once the pressure in the ventricles exceeds the pressure in the atria, the tricuspid and mitral valves close. (This is the______ heart sound)
Complete emptying of the atria into the ventricles makes up ~30% of total cardiac output. (this is sometimes called the “atrial kick”)

A

Active diastolic, S1

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17
Q

____________ reduce the amount of time chambers have to fill. Less fill equals less pressure.
THE SHORTER THE AMOUNT OF time spent in the ___________________ –THE LESS TIME THEY HAVE TO FILL –LOWERED cardiac output

A

High heart rates, DIASTOLIC PHASE

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18
Q

____________ of the cardiac cycle

Electrical stimulation down the bundle branches and through the Purkinje fibers sends a signal for the ventricles to contract (QRS complex on the ECG).

Ventricles squeeze and push blood forward through the pulmonic and aortic valves into the lungs and the aorta.

Once the pressure in the arteries exceeds the pressure in the ventricles, the pulmonic and aortic valves snap shut. (this is the ______ heart sound)

A

Systolic phase, S2

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19
Q

_____ is the highest pressure that occurs in the systolic phase, _____ is the lowest pressure that occurs in the diastolic phase.

A

SBP, DBP

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20
Q

The heart can only perfuse the coronary arteries during the __________.

A

diastolic phase

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21
Q

THE HEART CAN ONLY PERFUSE ITS CORONARY ARTERIES DURING THE ____________, NOTTTTTT THE ______________
HIGH HEART RATE WILL SHORTEN THE ____________ AND CAUSE LOW (cardiac output?)

A

DIASTOLIC PHASE, SYSTOLIC PHASE, DIASTOLIC TIME

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22
Q

What is cardiac output? What chambers are responsible for which percentage?

A

amount of blood pumped by the heart in 1 minute. 30% atria, 70% Ventricles

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23
Q

What is the formula for cardiac output?

A

CO = Heart Rate(Stroke volume)

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24
Q

What are ways to increase heart rate?

A

ANS stimulation, temperature, electrolytes, adrenal stimulation, and catecholamine release can all affect HR

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25
Q

_______ can decrease CO if the body is unable to compensate with an increase in SV

A

Slow HR

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26
Q

________ can decrease CO because the heart does not have enough time to fill with blood.

A

Fast HR

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27
Q

What factors affect stroke volume?

A

Preload, Afterload, and Contractility affect SV

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28
Q

____________ will decrease CO unless the body can compensate with increased HR.

A

Decreased SV

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29
Q

What is the normal cardiac output in adults?

A

4-8L in adults

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30
Q

______ –is volume dependent (if you have a dehydrated patient they will be tachycardic to compensate)

A

preload

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31
Q

___________ increases heart rate via the ANS

A

atropine

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32
Q

atropine increases heart rate via the ______

A

ANS

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33
Q

below __________ is when symptomatic bradycardia begins

A

50 bpm

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34
Q

Preload-

A

Stretch on the ventricular myocardium at the end of diastole.

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35
Q

preload: _____________________ dependent.

A

Volume and outside pressure

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36
Q

pneumothorax, hemothorax, cardiac tamponad, high peep. –these things cause increased pressure in the thoracic cavity which pushes against the heart and can potentially cause ____________________

A

decreased preload

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37
Q

Afterload-

A

resistance against which the ventricle must overcome to push blood forward.

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38
Q

Contractility-

A

the strength of muscle contraction in the myocardium

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39
Q

When is preload increased?

A

hypervolemia
regurgitation of cardiac valves

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40
Q

when is afterload increased?

A

hypertension
vasoconstriction

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41
Q

___________ is often volume-dependent. Increases in intrathoracic pressure also decrease ______, High PEEP, or pneumothorax can affect it. Drugs like ____________ decrease _________ because vesodilation decreases the amount of blood returning to the heart.

A

Preload, preload, nitroglycerine, preload

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42
Q

The ______ side of the heart is extremely preload dependent. NURSING INTERVENTIONS: ___________ (IS MOST COMMON THING THAT WILL FIX THIS), decrease peep possibly, chest tube for hemothorax.

A

right, FLUID BOLUS

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43
Q

Afterload is the _____________that the heart must beat against. Stenotic valves, pulmonary hypertension and systemic hypertension, vasopressors, _______________________ all ________ afterload.

A

downstream resistance , hypoxia, and hypothermia, increase

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44
Q

____________, ____________, and _________ all decrease contractility ( or ______ effect)

A

hypoxia, acidosis, and hypothermia, (inotropic)

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45
Q

Contractility is increased by positive inotropic meds such as digoxin levophed, dobutamine ________ and _________. Decreased by ___________, negative inotropes like _____________, ______________, ___________, ____________, hypoxia, acidosis, hypothermia. digoxin in a positive inotrope which increases contractility. many blood pressure meds decrease ___________ effects.

A

milrinone, hypercalcemia,

hypocalcemia

amiodarone, beta blockers calcium channel blockers and ace inhibitors

inotropic

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46
Q

_____________ and ____________ are positive inotropes as well as ____________.

A

Dobutamine and milarone, CALCIUM

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47
Q

cardiac index. define. give formula.

A

The volume of blood pumped by the left ventricle in 1 minute divided by body surface area. CO/BSA = Cardiac index

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48
Q

What is a normal cardiac index?

A

2.5-4.2 L/min/m^2

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49
Q

Is cardiac output or cardiac index preferred to use ? explain why.

A

Cardiac index is preferred measurement because it is a universal measurement no matter how big the person is.

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50
Q

ANYTHING BELOW _____ IS CARDIOGENIC SHOCK

A

2.0 (cardiac index scale)

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51
Q

PNEUMOTHORAX, BLEEDING are problems for ?

A

preload

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52
Q

What are common causes of afterload problems?

A

hypertensive crisis, someone who doesnt take their Heart failure meds

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53
Q

What are common preload problems?

A

pneumothorax, bleeding

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54
Q

low preload –_________

high afterload –__________________

A

fluids

control hypertension

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55
Q

Central Venous Pressure (CVP)

Values and what is it?

A

2-6 mm Hg

Pressure of blood in the right heart at the end of diastole. Preload of the right ventricle

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56
Q

Pulmonary Artery Pressure (PAP)
what is is and what are values?

A

Blood pressure in the pulmonary artery. PA diastolic pressure is almost the same as PAOP, so it is often substituted for PAOP. Safer than occluding PA cath.

15-25 mm Hg/8-15 mm Hg

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57
Q

Pulmonary Artery Occlusive Pressure (PAOP)

what is it and what are values?

A

Pressure of blood in the left heart at the end of diastole. Preload of left ventricle.

8-12 mm Hg

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58
Q

Stroke Volume (SV)

give definition and normal values

A

Volume of blood ejected from LV with each heartbeat.

60-130 mL/beat

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59
Q

Systemic Vascular Resistance (SVR).

define and give normal values

A

Resistance that LV must overcome to open aortic valve and push blood forward. Afterload of left ventricle.

770-1500 dynes/sec/m2

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60
Q

Pulmonary Vascular Resistance (PVR)
define and give normal values.

A

Resistance that RV must overcome to open Pulmonic valve and push blood forward. Afterload of right ventricle.

< 250 dynes/sec/m2

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61
Q

Mean Arterial Pressure (MAP)
define and give normal values.

A

Average blood pressure over 1 cardiac cycle. Important for end organ perfusion.

70-105 mm Hg

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62
Q

systemic vascular resistance (fancy name for_________ of the left ventricle)

pulmonary vascular resistance (fancy name for _____________)

A

afterload, pre load

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63
Q

KIDNEYS NEED ___________ MMHG MAP TO GET PERFUSION, ALL OTHER ORGANS CAN GET PERFUSION WITH THIS PRESSURE,

A

65-75

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64
Q

only difference between central venous O2 and mixed venous oxygen saturation is that ___________________________

A

Mixed venous oxygen has been through the coronary arteries

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65
Q

Central Venous Oxygen Saturation (ScvO2)
Normal Value ___________
is obtained from __________

A

65%-85%.

distal port of a central line or PICC line or CVP port of PA catheter.

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66
Q

Mixed Venous Oxygen Saturation (SvO2)
Normal Value ____________
Can be drawn from __________________________

A

60%-75%.

distal port of PA catheter.

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67
Q

Both values provide an assessment of the balance between oxygen supply and demand. ____________ values indicate an increased oxygen supply, a decreased oxygen demand or the inability to extract oxygen from the blood. ___________ values indicate decreased oxygen supply or increased oxygen demand.

A

Central venous oxygen saturation and mixed venous oxygen. High. Low.

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68
Q

__________________ is slightly higher because it is measured with blood above the ______________ thus the cardiac sinuses have not returned the oxygenated blood from the myocardium.

A

Central venous oxygen saturation, right atrium

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69
Q

__________ is drawn from the vena cava. has to be drawn from a ____________________________________

A

central venous O2, central line or through a port.

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70
Q

________________________ –is drawn from the distal end of a PA catheter only

A

mixed venous oxygen saturation

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71
Q

low O2 saturation indicates tissue is not picking up O2 (_______ not circulating blood to tissues) or theyre not picking up enough O2

A

low bp

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72
Q

What are non invasive ways to monitor hemodynamics?

A

Noninvasive blood pressure
assess for JVD
lactate measurement
urine output or EtCO2

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73
Q

Non-invasive blood pressure (NIBP):

Be sure to use an appropriately sized ________.
__________ measurement is preferred.

A

cuff, Upper arm

74
Q

Assessment for Jugular vein distention:

JVD occurs when the _____ is elevated
Measure JVD with the patient supine and the HOB at ______ degrees.

A

CVP, 30-45

75
Q

Lactate measurement:

Lactic acid is a byproduct of ________ metabolism.
Anytime the tissues are without adequate oxygen lactic acid is produced
It is a measure of how poorly perfused the tissues are
Goal when trending lactate is ______ reduction every ___ hours until normal.

A

anaerobic , >20%, 2

76
Q

lactic acid over ____ is associated with poor outcomes.

A

15

77
Q

NORMAL LACTIC ACID LEVELS ARE LESS THAN ___

A

2

78
Q

if your patient is making _____________, your patient is probably perfusing adequately

A

adequate urine

79
Q

What are invasive ways of hemodynamic monitoring?

A

art lines, CVA, PA lines

80
Q

What are the components of an invasive pressure monitoring system?

A

Invasive catheter
high pressure noncompliant tubing
transducer with a stopcock
pressurized flush system
beside monitor

81
Q

High-Pressure Noncompliant Tubing:

Tubing made specifically for hemodynamic monitoring
Tubing should be no longer than _________ inches
Minimize the number of _____________ bc it skews the pressers. use less than ___.

A

36-48, stopcocks, 3

82
Q

_________:

Turns intravascular pressure changes into waveforms and numerical data
Must be calibrated to atmospheric pressure by “zeroing” the system
The 3-way stopcock is known as the “__________” and is the reference point that is used for leveling

A

Transducer, air-fluid interface

83
Q

__________________:

Maintains patency of the tubing and catheter
Flush solution is placed in a pressure bag inflated to ___________ bc most peoples systolic will not be above ______, this keeps the line clear
Fluid will continuously infuse at ___________
Flush solutions are usually 0.9% NS or Heparinized solutions. Heparin solutions maintain catheter longer but increase risk for bleeding or HIT

A

Pressurized Flush System. 300 mm Hg, 300, 2-5 mL/hour,

84
Q

___________________:

Provide a visual display of hemodynamic waveforms and numeric information from the transducer
Store data for integration into the patient chart

A

Bedside Monitoring System

85
Q

What is the intracardiac pressure for the vena cava?

A

2-6 mm Hg

86
Q

What is the intracardiac pressure for the right atrium ?

A

2-6 mm Hg

87
Q

What is the pressure in the right ventricle during diastoly and systoly?

A

0-8 mm Hg diastolic
15-25 mm Hg systolic

88
Q

What is the pressure in the pulmonary artery diastolic and systolic?

A

8-15 mm Hg diastolic

15-25 mm Hg systolic

89
Q

What is the pressure of the left atrium ?

A

8-12 mm Hg

90
Q

What is the pressure of the left ventricle systolic and diastolic ?

A

110-130 mm Hg systolic

8-12 mm Hg diastolic

91
Q

What is the pressure in the aorta systolic and diastolic?

A

100-130 mm Hg systolic

60-90 mm Hg diastolic

92
Q

Validation of the accuracy of hemodynamic data is done by the nurse and has 4 major components:

  3. 4.
A

Patient positioning
Leveling the air-fluid interface with the phlebostatic axis
Zeroing the transducer
Assessing the dynamic response (Square Wave Test)

93
Q

Patients should be ______ if using the phleboststic axis (____ intercostal space, mid-thorax). HOB can be up to ___ degrees and still give accurate readings. If the patient is side-lying, then the 4th intercostal space mid-sternal point should be used. Imagine that your patient’s body is transparent and level the air-fluid interface with the atria.

A

supine, 4th, 60,

94
Q

The transducer must be leveled each time the patient is __________.

A

repositioned

95
Q

Low transducer will cause falsely ____ pressures, high transducer will cause falsely ____ pressures.

A

high, low

96
Q

When should the transducer be zeroed?

A

when the catheter is inserted
beginning of the shift
repositioning
when there are major changes in hemodynamic status.
possibly if there are atmospheric pressure changes

97
Q

Perform a _____________ to validate the accuracy of the transducer’s readings

A

square wave test

98
Q

What option is optimally dampened after the square waveform test?

A

A. A is optimally dampened- a small undershoot below baseline followed by one or two oscillations before returning to the normal wave form. Data is accurate.

99
Q

What option is over dampened after the square waveform test?

A

B is overdampened- the square wave test is followed by no oscillations, the upstroke is slurred, or a small undershoot is not produced.

100
Q

What option is underdampened after the square waveform test?

A

c

101
Q

Over dampened systems result in a _____________ pressure that is falsely low and a ___________________ pressure that is falsely high.

A

systolic blood, diastolic blood

102
Q

What causes overdampenening?

A

blood clots in system, air bubbles in tubing, loose connections, kinks in tubing, pressure bag is not inflated to 300 mm Hg.

103
Q

An under dampened system will result in falsely high ___________ pressures and falsely low ________________ pressures.

A

systolic blood, diastolic blood

104
Q

What causes underdampening ?

A

excessive tubing length, too many stopcocks, for unknown reasons, and due to patient anatomy.

105
Q

is underdampenign or overdampening harder to fix?

A

underdampening

106
Q

What is the most common artery used for art lines? which sites are considered dirty?

A

radial artery is most common. femoral and doraslis pedis are considered “dirty.”

107
Q

What should be done prior to inserting a radial artery line?

A

allen test

108
Q

What are complications of arterial lines?

A

thrombosis, embolism, blood loss, infection

109
Q

_______ air is way more dangerous than _________ air.

NEVER GIVE ANYTHING THROUGH AN ________

IT IS VERY IMPORTANT TO HAVE THE ___________ ON FOR YOUR PATIENT BC IF SOMETHING GETS DISCONECTED THEN THEY HAVE AN ARTERIAL BLEED

A

arterial, venous. ART LINE. ALARMS

110
Q

Care of arterial lines:

Routinely assess perfusion in the extremity. Color, temperature, pulse, sensation, and cap refill.
Keep the wrist in a ______ position. Use an arm board if needed. PREVENTS____________ AND DAMAGE THE TO ART LIN E

A

neutral, NERVE DAMAGE

111
Q

When the arterial line is removed, ensure hemostasis by applying manual pressure until bleeding stops. (minimum of ______________ for radial artery).
NEVER administer ____________ via an arterial line.

A

5 minutes, medications.

112
Q

Four is not important. What number indicates the systolic blood pressure?

A

1

113
Q

Four is not important. What number indicates the diastolic blood pressure?

A

3

114
Q

Four is not important. What is ocuring at 2 ? What is it called?

A

aortic valve is closing, dichrotic notch.

115
Q

To measure CVP hook the distal port of a CVC to the invasive pressure monitoring system. (be sure to ______________________ from the CVC)

A

remove the pressure cap

116
Q

Remember CVP is an estimate of the ___________________________ ventricle.
Always measure CVP at the end of expiration

A

preload of the right

117
Q

What are normal values of the Central Venous Pressure monitoring?

A

2-6 mm Hg

118
Q

_____ and ____ are equal and can be used interchangeably.

A

CVP and RAP (right atrial pressure)

119
Q

What waveform corresponds to a CVP waveform?

A

B

120
Q

Causes of High CVP/RAP:

_____________________
_____________________
_____________________
_____________________
Pulmonary hypertension
Pulmonary embolism
Mechanical ventilation

A

High CVP/RAP
Volume overload
Right Ventricular failure
Tricuspid or pulmonic valve failure

121
Q

Causes of High CVP/RAP:

High CVP/RAP
Volume overload
Right Ventricular failure
Tricuspid or pulmonic valve failure
_____________________
_____________________
_____________________

A

Pulmonary hypertension
Pulmonary embolism
Mechanical ventilation

122
Q

What are causes of low CVP/RAP?

A

Vasodilation
hypovolemia

123
Q

Remember: It is the nurse’s job to ensure that readings are accurate by: 1. __________________________ 2. _____________________________, 3. ____________________ 4. ______________________

A

positioning the patient, leveling the air-fluid interface, zeroing the system, and, performing a square wave test.

124
Q

An increase in pulse pressure greater than or equal to ____ is indicative of fluid responsiveness. This means you can give them a _____

A

9%, fluid bolus.

125
Q

_________________ at ___ degrees is gold standard for evaluating need for fluid bolus.

A

passive leg raises, 45

126
Q

_____________ are kind of being phased out –increases infection risk, we can use other things to get same info that ___ catheters give

A

PA catheters, PA

127
Q

PA catheters:

DON’T EVER LOOSE __________, YOU SHOULD NEVER ________________________________________

A

SYRINGE, ASPIRATE BACK ON THE SYRINGE

128
Q

Which waveform indicates the PA catheter is in the pulmonary artery?

A

3 from left

129
Q

Which waveform indicates the PA catheter is in the right atrium ?

A

1

130
Q

Which waveform indicates the PA catheter is in the right ventricle ?

A

2 from left

131
Q

Which waveform indicates the PA catheter is being wedged?

A

4

132
Q

What does the waveform for the right atrium look like?

A

v fib.

133
Q

What does the waveform for the right ventricle look like?

A

v tach with corresponding pressures

134
Q

What does the waveform for the pulmonary artery look like?

A

v tach with corresponding pressures

135
Q

What does the waveform for a PAOP or wedge pressure look like?

A

V fib with corresponding pressures

136
Q

Notice how the PAO waveform looks kinda like _____? If the PA is occluded for too long it can result in ______.

A

v-fib, death,

137
Q

PA cath:

________________________________ can occur when the provider passes the PA catheter through the ventricle. This should be resolved once in the____. Placement is verified by monitoring the _______________
The PA waveform has a dicrotic notch… it is indicative of ________________.

A

Ventricular dysrhythmias (V-tach), PA, waveforms and CXR., pulmonic valve closure

138
Q

pulmonary artery wedge is not really done anymore bc it can rupture the pulmonary artery and cause an aneurysm. Very important that you know that if wedge looks like __________ waveform you need to do something because it has migrated.

20 beats run of V tach when passing through the right ventricle is acceptable, don’t panick.

A

v fib.

139
Q

PA hemodynamic monitoring:

Useful when there is a possibility of ______ heart involvement or in lung dysfunction such as ___________________.

A

left sided, pulmonary hypertension

140
Q

PA monitoring:

_______________ or continuous CO catheters allow the nurse to directly measure cardiac output

A

Thermodillution

141
Q

PA cath:

__________ port lies in the ___________ and measures __________, can be used to administer ________, injection port for thermodilution CO measurements.

A

Proximal, right atrium, RAP (CVP), medications,

142
Q

PA cath:

___________ port sits in the pulmonary artery and measures PA pressures. Distal port is also where blood is drawn for _______________ o2 samples.

A

Distal, mixed venous

143
Q

PA occlusive pressure (PAOP) measurement is also possible if the balloon is briefly inflated. PAOP measurement carries a higher risk for patient injury. _____________ is needed to measure PAOP. _______________ is often substituted for PAOP since they are within a few mm Hg of each other (unless there is valve disease or significant pulmonary congestion).

A

Physician order, PA diastolic,

144
Q

As always, all pressures should be measured at the ______________________.

A

end of exhalation

145
Q

_________ is only the really way we can monitor pressure in the lungs.

A

pa catheter

146
Q

The PA catheter carries unique risks.

Arrythmia: usually occurs with catheter insertion or catheter migration. Support the patient. __________ the catheter if the arrhythmia does not resolve.
important that we know where the catheter is and that we don’t migrate it

A

Remove

147
Q

PA cath risks:

Right bundle branch block: RBBB is usually temporary. If the patient already has LBBB then this can cause _________________. Be prepared to _________ the patient.

A

complete heart block, pace

148
Q

Pulmonary Artery injury or PA rupture (most significant risk/ Mortality of 50%-75%): Presents as an episode of _____________ after catheter insertion or balloon inflation. risk is highest in pulmonary hypertension, hypothermia, and anticoagulation. PA rupture is usually caused by _________________________ of the catheter. Ensure insertion depth is assessed frequently, do not inflate balloon unless ordered and necessary, ensure balloon inflation port is locked when not in use, never use any syringe but the one that comes with PA catheter, maximum of ______ of air to inflate the balloon.

A

hemoptysis, overinflation of the balloon or migration, 1.5ml

149
Q

___________________ IS A S/S OF PA RUPTURE

A

COUGHING UP BLOOD

150
Q

What is the most common complication of central lines?

A

infection

151
Q

What is the most deadly complication of central lines?

A

infection

152
Q

What are complications of central venous lines?

__________________
______________________
________________________
accidental placement in the carotid artery
infection

A

pneumothorax/hemothorax
air embolism
laceration/perforation of major vessels

153
Q

What are complications of central venous lines?

pneumothorax/hemothorax
air embolism
laceration/perforation of major vessels
_______________________
_______________________

A

accidental placement in the carotid artery
infection

154
Q

Complications of Central venous lines:

Pneumothorax/Hemothorax: usually occurs ___________________. Prepare to insert a _______________ if present.

A

immediately after insertion, chest tube

155
Q

Complications of Central venous lines:

Air Embolism: can occur _______________ if connections are not ________. Ensure pressure caps are in place. Most common when the line is ______________________________. Place patient ________________________________________

A

at any time, tight, inserted and removed, Trendelenberg on left side, give 100% O2.

156
Q

what position is this?

A

trendelenberg

157
Q

Complications of central venous lines;

Laceration/Perforation of major vessels. If hematoma forms ____________________________________

A

hold direct pressure and notify physician

158
Q

Complications of central venous lines;

Accidental placement in the carotid artery: ________________________________________________________________________________________

A

never remove a line placed in the carotid, must be removed by vascular surgeon.

159
Q

Complications of central venous lines:

most common?

A

infection

160
Q

Complications of central venous lines:

most deadly?

A

infection

161
Q

How to Reduce Central Line-Associated Infection:

_______________
_____________________
_________________________
_______________________________
Remove lines as soon as possible
Maintain intact dressing on the site
Use CHG-impregnated dressings at the insertion site.
Scrub the hub prior to all access of CVC ports.
Daily CHG bathing

A

Hand Hygiene
Use maximum sterile barriers when inserting lines.
Prep the skin with CHG scrub prior to inserting the line
Subclavian site is preferred, followed by IJ site and femoral site

162
Q

How to Reduce Central Line-Associated Infection:

Hand Hygiene
Use maximum sterile barriers when inserting lines.
Prep the skin with CHG scrub prior to inserting the line
Subclavian site is preferred, followed by IJ site and femoral site
______________________________
___________________________________
_______________________________________
________________________________________
_______________________________________

A

Remove lines as soon as possible
Maintain intact dressing on the site
Use CHG-impregnated dressings at the insertion site.
Scrub the hub prior to all access of CVC ports.
Daily CHG bathing

163
Q

IF THEY put a central line IN A CODE situation and it was rushed what should you do?

A

YOU NEED TO GET IT OUT ASAP. bc its going to cause an infection

164
Q

What increase CO/CI?

A

Elevated HR from: activity, anemia, metabolic demand such as seizures or shivering, adrenal disorders, fever, anxiety.

165
Q

What increases SV?

A

Increases in preload from fluid resuscitation or changes in ventricular compliance

166
Q

What decreases SV?

A

Decreases in afterload from vasodilation from meds or sepsis, decreased blood viscosity (anemia), increased contractility, and hypermetabolic states

167
Q

What decreases CO/CI?

A

HR that is too fast or too slow resulting in inadequate ventricular filling
Stroke volume reduction as a result of:

168
Q

What decreases stroke volume?

A

Stroke volume reduction as a result of:

Decreased preload from hemorrhage, hypovolemia, vasodilation, and fluid shifts

Increased afterload from vasoconstriction or increased blood viscosity

Decreased Contractility from myocardial infarction/ischemia, heart failure, cardiomyopathy, cardiogenic shock, cardiac tamponade.

169
Q

what does thermodilution measure?

A

cardiac output manually

170
Q

The nurse will inject a set volume of ___________________ 0.9% NS into the proximal port of the PA catheter. The thermistor measures the temperature of the blood and calculates a curve where the area under the curve equals CO

An ___________of several injections is usually taken

Do not infuse ______ into the proximal port if thermodilution CO is being used
Inject the solution at ________________

A

room-temperature, average, meds, the end of expiration. typically a series of 3 or 5 measurements are taken.

171
Q

what is the manual way to calculate cardiac output?

A

thermodilution cardiac output

172
Q

what is the automatic way to measure cardiac output?

A

continuous cardiac output

173
Q

The thermal filament heats up blood at routine intervals and the thermistor measures the temperature creating a washout curve

An average is taken over ____seconds

Not useful in patients who are _______________________ since the thermal filament only heats blood to 44 degrees C maximum

A

continuous cardiac output, 60, hyperthermic

174
Q

Are PA catheters worth it?

Use of PA catheters has decreased since evidence suggested that their use increased _________________
PA catheter pressures only estimate _______ and can be affected by outside forces such as stiff ventricles or increased ______.

A

mortality, preload, PEEP

175
Q

_________ should not be used as a sole decision-making point regarding fluid management
_____________ for example. you cannot base it off one reading of ________

A

CVP, leg raises, CVP

176
Q

t/f: Research has shown no difference in mortality in patients managed with a PAC vs. those managed without a PAC

A

true.

177
Q

Non-invasive hemodynamic monitoring and new devices that measure ____________________________ are currently where hemodynamic monitoring is shifting.

A

SV and changes in SV

178
Q

Monitor attaches to an arterial line and measures variation in stroke volume

A

Pulse contour methods of hemodynamic assessment

179
Q

What is necessary to use a pulse contour for hemodynamic assessment?

A

full mechanical ventilation

180
Q

t/f: full mechanical ventilation is necessary for pulse contour method?

A

true

A&C II EXAM II (4 decks)

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