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Flashcards in Arterial pressure monitoring Deck (26)
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What are the sites for art line placement?

Radial, dorsalis, femoral, brachial


What are the pros / cons of radial art line?

Pros: Superficial, easy to locate and cannulate, can perform allens test for collateral circulation

Cons: Thrombus with long term use, sometimes difficult to palpate, contraindicated in arm with AV fistula, decrease accuracy with peripheral constriction


What are the pros / cons of dorsalis art line?

Used when radial not accessible, easy

Cons: Usually inaccurate d/t small artery, risk of occlusion, pt unable to ambulate


What are the pros / cons of femoral art line?

Used in cardiac arrest, shock states when peripheral pulses not palpable

Cons: Prone to kinks, risk of infection, hemorrhage, needs to be sutred in


What are pros / cons of brachial art line?

Easy to access in OR, good collateral vessels

Cons: Rarely used, hard to stabilize, risk of brachial nerve damage


How much pressure should the pressure device be inflated to?

250-300mm Hg


Where is the art line transducer leveled at?

With the right atrium, at the phlebostatic axis (4th ICS, midaxillary line)


What happens if the transducer is above the phlebostatic axis?

False decreased BP


What happens if the transducer is below the phlebostatic axis?

False elevated BP


What are the 3 pressures the art line is exposed to?

1) Blood pressure
2) Atmospheric pressure
3) Hydrostatic pressure


What are the characteristics of a normal art line waveform?

Smooth upscale (systole) and diacrotic notch (beginning of diastole) quick downwards slope


What does a dampened waveform look like, and what causes it?

Waveform appears smaller in amplitude, loss of diacrotic notch.

Can be caused by kink in the catheter, air in transducer, inaccurate leveling, pressure in pressure bag, clots. CHECK MANUAL CUFF to confirm pressure.

Arrythmias can cause irregular, dampened waveforms


What is pulsus parodoxus?

Decrease of > 10mmhg SBP between inspiratory and expiration

Decrease on inspiration, increase on expiration


What causes pulsus parodoxus?

Hypovolemia, pericardial tamponade


What is the square wave test?

Pulling the flush cable should cause quick rise up, square shape, sharp fall down and 1 oscillation.

Checks integrity of transducer accuracy.


What does an over-dampened square wave test look like and what does it represent?

No oscillations, square has slope downwards (not sharp), doesn't go below baseline.

Results in false low BP


What does an over-sensitive / under-dampened square wave test look like and what does it represent?

Many oscillations, pressure very peaked

Results in false high BP


What are complications of art line?

Hemorrhage, hematoma (can occlude blood flow, causing ischemia), infection, air emboli, ischemic limb


What are some ways to prevent air emboli in art line?

Check integrity of all ports, stopcocks, tubing, connection sites. Air should be aspirated out of NS bag prior to pressurizing


What should be checked prior to art line removal?

Coag studies, platelet count


How long should pressure be maintained on the site after art line removal?

5-20 mins


Troubleshooting: Dampened arterial waveform

Check manual BP
Possible air in line or transducer
Kink in catheter
Decreased pressure in flush bag?
BRoken transducer?
Potential clot


Troubleshooting: Art line has a clot

Aspirate clot, do not fast flush


Troubleshooting: Flat line

Stopcock turned incorrectly?
Catheter out of artery?
Complete occlusion / clot?


Troubleshooting: No waveform

Check connection to monitor


Troubleshooting: Unable to aspirate blood

Possible arterial spasm --> aspirate slowly and gently

Catheter against vessel wall --> Reposition limb

Kinked at site --> Redress, inspect catheter