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PMI > 12. Arterial Lines > Flashcards

12. Arterial Lines Flashcards

1
Q

what can happen if the art line tubing becomes disconnected?

A

the pt could rapidly bleed to death

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2
Q

2 purposes for arterial lines

A
  1. real time blood pressure
  2. blood samples
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3
Q

how often does an art line provide blood pressure

A

every time the heart beats

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4
Q

why cant you draw blood out of an IV?

A

pressure in veins is too low (7mmHg)
vein would flatten

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5
Q

adult art line sizing

A

20ga
18ga

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6
Q

radial/brachial catheter size

A

20ga

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7
Q

femoral catheter size

A

18ga

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8
Q

peds art line sizing

A

20-22ga

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9
Q

neonates art line sizing

A

22-24ga

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10
Q

NIBP reading vs art line

A

NIBP under-reads systolic
NIBP over-reads diastolic

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11
Q

Art line vs NIBP

A

Art systolic is higher than NIBP
Art diastolic is lower than NIBP

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12
Q

gold std for BP monitoring

A

arterial lines

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13
Q

pressure transducer

A

senses BP inside artery

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14
Q

why do some providers use heparinized saline?

A

less chance of art line system clotting

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15
Q

why do some providers not use heparinized saline?

A

eliminates possiblity of HIT

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16
Q

2 purposes of pressure bag

A

prevents blood from backing into tubing
allows fluid flush of artery

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17
Q

when the 500mL bag of N/S is pressurized, it allows

A

the pressure in the tubing to be higher than the pressure in the blood

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18
Q

when do you fluid flush an art line into the pt

A

after labs are drawn to flush the blood back into the pt

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19
Q

can you give drugs through an arterial line

A

no

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20
Q

why should you not give drugs via art line

A

cause vasoconstriction and ischemia

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21
Q

what should never be flushed into artery

A

air bubbles

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22
Q

which direction should the stopcock be turned in order to flush?

A

off to air

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23
Q

4 reasons an art line wont flush

A
  1. stopcock turned off to the line
  2. closed roller clamp
  3. “under pressurized” pressure bag
  4. clotted off catheter
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24
Q

how to fix a clotted off art line?

A

try to aspirate clot w/syringe
flush line

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25
Q

materials required to insert art line

A

chloraprep
guaze
tegadern
tape
lidocaine
arrow/angiocath
wrist support/roll

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26
Q

2 catheter types for art lines

A

20ga arrow catheter
regular 20ga catheter

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27
Q

what pressure do you inflate the N/S bag to?

A

250-300mmHg

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28
Q

what rate will the fluid drip into the artery with a correctly pressurized bag?

A

3-6mL per hour

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29
Q

when can the transducer be exposed to the atmosphere?

A
  1. if the stopcock if off to the pt, the stopcock will be open to air
  2. before the link is hooked up to the catheter in the artery
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30
Q

how do you zero the art line?

A

open the system to the atmosphere
press “zero”

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31
Q

steps to zeroing transducer

A
  1. change monitor to 8 wave
  2. turn stopcock OFF to pt (OPEN to air) and remove cap
  3. push zero
  4. turn stopcock OFF to atmosphere
  5. replace cap
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32
Q

what direction is the stopcock off to pt

A

away from transducer
towards noncompliant tubing

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33
Q

MAP

A

area under the curve

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34
Q

upstroke

A

systole
cardiac contractilioty

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35
Q

sharp vertical upstroke

A

good contractility

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36
Q

sloped sluggish upstroke

A

poorer contractility

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37
Q

downstroke

A

diastole
SVR

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38
Q

slow fall downstroke

A

vasoconstriction
high SVR

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39
Q

shar fall downstroke

A

vasodilation
low SVR

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40
Q

dicrotic notch

A

diastolic blood hits the aortic valve

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41
Q

overdamped waveform

A

smoother/lower amplitude

underestimates systolic
overestimates diastolic
no change to MAP

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42
Q

are overdamped waveforms accurate?

A

overdamped waveforms are inaccurate

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43
Q

causes of damping in waveform

A
  1. partially clotted catheter
  2. kinked catheter from wrist flexion
  3. compliance in tubing
  4. low pressure in system
  5. air bubbles
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44
Q

why is art line tubing non-compliant?

A

to reduce dampning
increase pressure accuracy

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45
Q

how to fix dampened wave form?

A
  1. aspirate blood/flush tubing
  2. extend wrist
  3. ensure adequate pressure (250-300 mmHg)
  4. aspirate air bubbles
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46
Q

underdamped waveform AKA

A

hyperresonant waveform
waveform w/overshoot

47
Q

underdamped waveform BP effects

A

overestimated systolic
underestimated diastolic
MAP unchanged

48
Q

underdamped waveform characteristics

A

too much detail

49
Q

causes of underdamped waveform

A
  1. defective transducer
  2. tachycardia
50
Q

most likely cause of underdamped waveform

A

defective transducer
just replace it

51
Q

square wave high pressure test

A

flush of system and evaluate waveform

52
Q

optimally damped

A

flush system
wave returns to baseline after 1 oscillation

53
Q

underdamped

A

flush system
wave oscillates multiple times before returning to baseline

54
Q

overdamped

A

flush system
wave does not oscillate
wave returns to baseline immediately

55
Q

constructive interference of waves

A

waves of similar frequencies are additive

combine to form higher peak amplitude

56
Q

natural (resonant) frequency of art line

A

20Hz

57
Q

fundamental frequency of art line

A

1-2 Hz

58
Q

what is the fundamental frequency derived from

A

pulse rate

59
Q

fundamental frequency of 60bpm HR

A

1 Hz

60
Q

fundamental frequency of 120bpm HR

A

2 Hz

61
Q

at what frequency ratio can the wave from become distorted/inaccurate?

A

if natural freq < 10x fundamental freq

62
Q

what is the most common cause of constructive interference?

A

tachycardia

63
Q

what can tachycardia cause in a art line

A

resonance
underdamping
– artificially high systolic

64
Q

resonance occurs when

A

a wave gets bigger because external force w/similar frequency was applied to it

65
Q

what can counteract resonance

A

damping

66
Q

an optimally damped system has a damping coefficient of

A

0.6-0.7

67
Q

high damping coefficient

A

ovedamped waveform

68
Q

low damping coefficient

A

underdamped waveform

69
Q

most common arterial line insertion sites

A

radial

70
Q

the radial is commonly used because

A

superficial location
low complication rates

71
Q

radial artery controls blood supply to

A

digits

72
Q

ulnar arterial line

A

more difficult
deeper
increased chance of nerve damage

73
Q

when do you avoid ulnar placement

A

if ipsilateral radial attempt has failed

you could lose all blood supply to hand

74
Q

brachial arterial line

A

only used if other sites are not available

limited collateral circulation
hemorrhage risk

75
Q

axillary arterial line

A

high risk of nerve damage to brachial plexus
highest risk of cerebral emboli

76
Q

why is the axillary artery the highest risk of cerebral emboli

A

most proximal to the brain

left is slightly safer than right axillary

77
Q

where is the highest risk of cerebral emboli

A

right side axillary artery

78
Q

what is the largest arterial line site

A

femoral artery

79
Q

where do you palpate for femoral pulse

A

inner thigh
mid-inguinal point

80
Q

when do you place a femoral line

A

emergency only

81
Q

when are femoral lines contraindicated

A

if pt has a femoral central line on same side
(leads to arteriovenous malformation)

82
Q

femoral art line complications

A
  1. hole in femoral artery
  2. possible femoral nerve damage
  3. higher infection rates
83
Q

NAVEL

A

Nerve
Artery
Vein
Empty
Lymphatics

femoral line placement

84
Q

most distal art line sites

A

dorsalis pedis
posterior tibial

85
Q

art line waveforms at distal sites

A
  1. waveform becomes more dampened (loses detail)
  2. higher systolic
  3. lower diastolic
    4, unchanged/slight lower MAP
86
Q

why is the waveform more dampened at distal sites

A

proximal arteries absorb pressure
more compliance loss by the time the blood reaches distal site

87
Q

Arteries: Proximal to Distal

A

aortic root
subclavian
axiallary
brachial
radial
femoral
dorsalis pedis

88
Q

BP reading in distal arteries

A

higher resonance = higher BP

89
Q

allen’s test

A
  1. exsanguinate hand (make fist)
  2. occlude radial/ulnar
  3. relax hand
  4. release ulnar pressure
90
Q

positive allen test

A

adequate collateral circulation
<7 seconds

91
Q

uncertain allen test

A

8-15 seconds

92
Q

negative allen test

A

inadequate collateral circulation
>15 seconds

93
Q

allen’s test indicates what

A

whether or not ulnar collateral circulation to hand is adequate

94
Q

do we use allens test

A

not really
its nonspecific

95
Q

what is a replacement for allens test

A

monitor pulse ox during occlusion of radial artery

96
Q

art line complications

A
  1. limb ischemia
  2. neurologic injury
  3. infection
  4. hemorrhage
  5. data misinterpretation
97
Q

causes of limb ischemia

A

thrombosis
too small of vessel for catheter
medication injection into artery
vasospasm

98
Q

causes of neurologic injury

A

needle injury
hematoma adjacent to nerve
prolonged wrist extension
stroke

99
Q

why do you not perform continuous flush of art line

A

risk of thrombus or air emboli

100
Q

which has a higher infection rate, arterial line or central line?

A

central lines are more likely to be infected

101
Q

arterial line transducer should be leveled to…

A

the phlebostatic axis

102
Q

for every ____ the transducer is below the catheter, the fluid pressure increases by ______

A

for every 1 inch the transducer is below the catheter, the fluid pressure increases by 1.87 mmHg

103
Q

transducer below level of heart

A

overestimates BP

104
Q

transducer above level of heart

A

underestimates BP

105
Q

transducers in sitting pts should be leveled

A

transducers should be leveled to the external auditory meatus in sitting pts to know the BP at the brain

106
Q

in sitting pts, transducers at the level of the heart will _______ BP at the level of the head

A

overestimate BP

actual BP will be lower than reading

107
Q

in sitting pt, if you level the transducer at the external auditory meatus, you will ________ pressures.

A

understimate CVP
underestimate PAP

108
Q

will art line BP change if pt moves their arm with the cather inserted?

A

no

the pressure reading is based off of transducer location, not cather location.

109
Q

pulsus bisferians

A

2 dicrotic notches

110
Q

causes of pulsus bisferians

A
  1. hypertropic cardiomyopathy
  2. severe aortic regurgiation
111
Q

hypertrophic cardiomyopathy

A

enlarged interventricular septum
narrows left ventricular outflow tract

112
Q

severe aortic regurge

A

blood reenters LV during diastole
temporaroly decreases blood flow during mid-systole

113
Q
A

PMI (18 decks)

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