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Arterial Lines Flashcards

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1
Q

2 purposes of arterial lines

A
  1. provide a real time blood pressure

2. arterial lines provide constant access blood samples to send for lab results

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2
Q

what is the catheter size for radial/brachial used for adults?

A

20 ga

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3
Q

what is the catheter size for femoral used for adults?

A

18 ga

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4
Q

what is the catheter size for pediatrics

A

20-22 ga

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5
Q

what is the catheter size for used for neonates?

A

22-24 ga

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6
Q

automatic bp machines tend to __(under read or over read) systolic bp and tend to ___ (under read or over read) diastolic bp

A

under read; over read

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7
Q

arterial lines which is most likely to be elevated?

A

systolic bp

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8
Q

Name the 5 materials for the pressure transducer system

A
  1. 500 ml NS bag
  2. arterial line tubing (noncompliant tubing) that contains a pressure transducer
  3. pressure transducer cable
  4. pressure bag for 500 ml NS bag
  5. transducer holder
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9
Q

what does the transducer do?

A

tells you how many mm Hg are generated with each pulse

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10
Q

why use heparinized saline?

A

system less likely to clot

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11
Q

what would happen if you did not use a pressurized bag ?

A

blood from the artery would back up into the tubing

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12
Q

what is the purpose of pressurized bag?

A

when the 500 mL NS is pressurized it exceeds arterial pressure and ALLOWS TO FLUSH FLUID INTO ARTERY

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13
Q

how do you flush an arterial line?

A

open the roller clamp and compressing the wings on the transducer

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14
Q

when should you flush fluids into an artery?

A

immediately after drawing blood labs from arterial line

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15
Q

what could happen if drugs are given the arterial route?

A

intense vasoconstriction and ischemia

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16
Q

what are the 4 possible reasons an arterial line wont flush?

A
  1. the stopcocks could be turned off to the line
  2. the pressure bag is under pressurized
  3. the roller clamp on the aline tubing could be closed
  4. the aline catheter could be clotted off
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17
Q

what pressure should the bag be pressurized?

A

300 mm Hg

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18
Q

how much fluid per hour will drip into the artery?

A

3-6 mL

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19
Q

what is the purpose of zeroing the arterial line?

A

eliminating the effect of atmospheric pressure has on bp reading

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20
Q

what should you change on the monitor for zeroing the transducer?

A

change from standard to arterial line tracing 8 wave

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21
Q

what could happen if the stopcock is turned the wrong direction off towards the transducer instead of patient?

A

it will bleed back and the pt could bleed to death

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22
Q

what should you do once the monitor shows a 0?

A

turn the stopcock off to the atmosphere again THEN put cap back on stopcock

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23
Q

7 things required for cannulating the artery

A
  1. chloraprep
  2. gauze
  3. tegaderm
  4. tape
  5. plastic “wrist support”
  6. lidocaine “skin wheel”
  7. angiocath
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24
Q

what are the two catheter options for cannulating the artery?

A
  1. 20 ga arrow catheter

2. 20 ga regular catheter

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25
2 options for an Aline wrist extender
1. plastic "wrist support" | 2. rolled up towel under the wrist
26
how do you calculate MAP with a line waveform?
area under the pressure curve
27
correlates with cardiac contractility
upstroke
28
what indicates good cardiac contractility?
sharp vertical upstroke
29
correlates with SVR
downstroke
30
a slow fall or high SVR indicates ___
vasoconstriction
31
a sharp fall or low SVR indicates ____
vasodilation
32
why do you see a dichrotic notch on the A line waveform?
closing of AORTIC valve
33
more sluggish upstroke and downstroke indicates ___ and ___
lower contractility and higher SVR
34
steeper upstroke and downstroke indicate ____ and ____
higher contractility and lower SVR
35
what does a dampened waveform mean?
gives inaccurate bp; underestimates the systolic BP (makes you think systolic bp is lower than it really is) and overestimates the diastolic bp while the MAP is unchanged
36
5 causes of dampened waveform
1. compliance in the tubing 2. a partially clotted off catheter 3. a kinked catheter from a flexed wrist 4. low pressure in the system
37
how do you fix a dampened a line waveform ? (4)
1. try to aspirate the blood and/or flush the tubing 2. try extending the wrist 3. make sure the system is pressurized to 300 mm Hg 4. look for air and aspirate any air bubbles
38
before treating hypotension you have to make sure of what two things?
1. the low bp reading is not due to a dampened waveform | 2. the transducer is appropriately leveled
39
3 effects of underdamped waveform
1. an overestimation of systolic bp 2. an underestimation of diastolic bp 3. MAP is unchanged
40
6 causes of an underdamped waveform
1. a defective transducer 2. tachycardia 3. long tubing 4. movement of catheter inside the artery 5. a catheter that is too large for vessel 6. increased vascular resistance
41
in an optimally damped waveform when does the wave return to baseline?
after one oscillation
42
in an underdamped waveform how often does the wave oscillate before returning to baseline?
oscillated multiple times
43
when the wave returns to baseline without any oscillations what waveform is this characteristic of?
overdamped waveform
44
term used when an arterial line system is pressurized it oscillates at a certain frequency
natural or resonant frequency
45
the fundamental frequency is equal to __
pulse rate
46
what is the fundamental frequency when the heart rate is 60 beats per minute?
1 Hz
47
what is the fundamental frequency when the heart rate is 120 beats per minute?
2 Hz
48
the fundamental frequency of an a line waveform should normally be between ___ and ___ Hz
1 and 2
49
the natural frequency is how much more than the fundamental frequency?
10 x
50
when two or more waves of similar frequency coincide to produce a single wave with a higher peak amplitude
constructive interference
51
when the wave gets bigger because b/c external FORCE with a similar frequency was applied to it
resonance
52
what becomes a factor if the natural frequency and fundamental frequency are similar?
resonance
53
when is resonance more likely?
decrease in natural frequency or increase in fundamental frequency
54
what can counteract resonance?
damping
55
how can you measure the amount of damping?
damping coefficient or damping ratio
56
a high damping coefficient= ___ waveform
dampened
57
name the arterial line cannulation sites
1. radial arterial line 2. ulnar arterial line 3. brachial arterial line 4. axillary arterial line 5. femoral arterial line 6. dorsalis pedis and posterior tibial (most distal)
58
what is the most common and preferred arterial cannulation site?
radial arterial line
59
<7 seconds time for blood to return to hand
positive allen's test; adequate collateral circulation
60
8-15 seconds time for blood to return to hand
uncertain; questionable allen's test
61
>15 seconds time for blood to return to hand
negative allen's test; inadequate collateral circulation
62
carries the highest risk of cerebral emboli
axillary arterial line
63
an embolus from an axillary arterial line is more likely to enter cerebral circulation through what side?
RIGHT
64
What are the complications for femoral lines? (3)
1. a hole in the back of the femoral artery 2. possible femoral nerve damage 3. potentially higher infection rates
65
which arterial site gives the highest systolic BP, lower diastolic, and lower mean BP readings and dampened wave form ?
distal; dorsalis pedia/posterior tibial
66
5 complications from arterial line complications
1. limb ischemia 2. neurologic injury 3. infection 4. hemorrhage 5. misinterpretation of data
67
the pressure of the artery at the base of the foot in a person who is standing is how much higher than the top of the head?
133 mm Hg
68
when will gravity or hydrostatic pressure affect blood pressure readings?
anytime pt is NOT lying flat
69
located at the 4th intercostal space along the mid axillary line
phlebostatic axis
70
phlebostatic axis represents the external location of ___
right atrium
71
where is central venous pressures not influences by hydrostatic pressures?
phlebostatic axis
72
where should bp readings be taken?
at the level of the heart
73
what will happen if the transducer is below the level of the heart?
overestimates blood pressure
74
what will happen if the transducer is above the level of the heart?
underestimates the blood pressure
75
how much does the fluid pressure increase if the transducer is below the tip of the catheter?
1.87 mm Hg
76
for sitting pts where should the transducer be placed ?
external auditory meatus
77
how much does the pressure in the transducer increase when raising the arm? what is unchanged?
15 cm H20; overall bp reading at the transducer unchanged

PMI (21 decks)

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