3 (B) Monitoring and Equipment in ICU Flashcards
(36 cards)
In ICU equipment, physios must
- Assess baseline values
- Know the practicalities
- Modify techniques or timing
- Monitor changes during treatment
What are types of haemodynamic monitoring
• ECG • Arterial catheter (art line) – Modified for PiCCO technology • Central venous catheter (CVC) (central line) • Pulmonary artery catheter (Swan Ganz)
What does the ECG measure. When might you pay attention to it?
- Heart rate
- Rhythm
When you’re about to do percussion
When can an arterial line be?
• Radial / femoral / dorsalis pedis
Practicalities of an arterial line
– Radial commonly splinted
– Monitor bp (systolic, diastolic, mean)
– Samples for blood gas analysis
Baseline values arterial line
- 100‐140/60‐90, 80‐100 mmHg
* MAP = DBP + 1/3(SBP‐DBP)
Things to note with arterial line
• Modify techniques or timing (eg flexion of wrist can affect wave) • Zeroing • Movement – Site visible – Axis altered – Kinking – Leaking • Disconnection – pressure
Practacalities central venous catheter
– Measures central venous pressure (CVP)
– Delivers fluids /drugs
– Not useful during physiotherapy treatment
Baseline values central venous catheter sponatenous breathing
• Baseline values: spontaneous breathing 3‐15 cm H2O – Increased with PPV – High ‐ volume, pulmonary HT, LVF – Low ‐ volume, peripheral vasodilation
Where can central venous catherter be inserted
Internal jugular vein
• Subclavian vein
What is a PiCCO
Pulse‐induced Contour Cardiac Output
– Minimally invasive continuous CO monitoring
– Thermodilution catheter in the femoral or axillary artery
and a CVC
What is a PA
Pulmonary Artery Catheter (PA)
• A balloon tipped flow directed catheter
• Via central vein to right heart – rests in pulmonary
artery
• Baseline values (all mm Hg; systolic/diastolic)
Uses of a PA catheter
3
PiCCO
• Pulse‐induced Contour Cardiac Output
– Minimally invasive continuous CO monitoring
– Thermodilution catheter in the femoral or axillary artery
and a CVC
Pulmonary Artery Catheter (PA)
• A balloon tipped flow directed catheter
• Via central vein to right heart – rests in pulmonary
artery
• Baseline values (all mm Hg; systolic/diastolic)
PA catheter
Uses:
• Left‐sided heart failure
• Titration of vasoactive drugs
• Severe respiratory failure to optimise fluid treatment
• Perioperative/postoperative surgical procedure with
cardiovascular ± pulmonary dysfunction
Practicalities of a PA catheter
• Practicalities: – Internal jugular – CXR post insertion – Wave form – Complications
Modification of techniques or timing with PA catheter
• Modify techniques or timing:
– May be confined to bed
– Monitor changes during treatment
– Treatment post removal
Types of respiratory monitoring
- Pulse oximetry
- ABG
- End tidal CO2
- Peak and pause airway pressure
Difference Sp02 and Sa02
Sp02 - saturation of peripheral 02
Sa02 - needs blood gas done
Things that stop pulse oximetry being reliable
Movement
Not being on correctly
Poor circulation
Nail polish
What is PETC02
End Tidal C02
– estimate of PaCO2 (from PACO2)
– changes in CO2 production
– continuous data (trends) not intermittent
– main factor difference in PaCO2 and PETCO2
• deadspace ventilation (lack of Q)
– advantages – non invasive
Practicalities of PETC02
– ETT placement (oesophagus, bronchi)
What changes to monitor on end tidal C02 (PETC02)
Monitor changes during treatment – Occlusion, dislodging – Ventilation adjustments (PaCO2‐ETCO2 gradient) • PEEP • Clefts in the plateau phase – Bronchospasm
What is peak inspiratory pressure
• Peak inspiratory pressure (PIP < 40 cmH2O)
– maximum pressure in a set tidal volume
– varies due to resistance
What is plateau pressure
• Plateau pressure
– end inspiratory pressure during a period of no gas flow
– plateau pressure should not exceed
What is mean airway pressure
• Mean airway pressure
– average of the system pressure over the entire ventilatory period
