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CVP Monitoring Flashcards

1
Q

What is CVP?

A

Central venous pressure

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2
Q

What is preload?

A

Preload = tension in muscle

How displaced/stretched the muscle is from its resting position

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3
Q

What is preload formula?

A

T = r x V / 2 x C

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4
Q

How do you assess volume status by the above preload formula?

A

By looking at how efficient the muscle of the RV is

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5
Q

According to the Frank-starling principle, what pressure will the CVP reflect if elasticity remains the same and you have to use the equation to determine a number?

A

LVEDV

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6
Q

What 2 ways can you look at and determine RVEDV?

A

TTE (transthoracic ECHO)

TEE (transesophageal ECHO)

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7
Q

If something is less compliant, it will have higher or lower pressure?

A

HIgher pressure

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8
Q

When placing a CVP catheter, how will you know you enter the RA?

A

The pressure waveform will give 2 distinct parts per cardiac contraction
(AC waveform and XVY waveform)

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9
Q

What are the letters corresponding to a CVP waveform?

A 
A
C
X
V
Y
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10
Q

What is the A waveform?

A

Atrial contraction

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11
Q

What is the C waveform?

A

Ventricular contraction that shows an upward peak from tricuspid valve bulge from increase in P from ventricle

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12
Q

What is the X waveform?

A

Nadir wave that is late ventricular ejection once Pulmonary valve has opened pulling the tricuspid valve into chamber

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13
Q

What is the V waveform?

A

Is the passive return of blood into the RA from the systemic circulation

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14
Q

What is the Y waveform?

A

Opening of the tricuspid valve that begins the push of blood into the right ventricle

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15
Q

What parts of waveform are considering to be in systole?

In diastole?

A

CXV in systole

AY in diastole because they are filling

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16
Q

The A wave of CVP waveform marks what?

A

End of diastole

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17
Q

The C wave of CVP waveform marks what?

A

Beginning of systole

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18
Q

The V wave if present because of what mechanical event?

A

Filling of atrium

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19
Q

How is CVP measured and charted by anesthesia ?

A

As a mean pressure

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20
Q

As far as breathing patterns are concerned, when should CVP measurements be taken?

A

End expiration

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21
Q

When recording CVP pressures during spontaneous ventilation, what should mean CVP be?

A

14 mmHg

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22
Q

When recording CVP pressures during positive pressure ventilation, what should mean CVP be?

23
Q

Cannon wave are seen with what physiological occurrence?

A

Conduction blocks

24
Q

Cannon waves are reflective waves in pressure that can be seen when the atrium contracts against a closed valve, this will produce what kind of CVP reading?

A

Falsely high CVP readings

25
Regurgitant CV waves can be seen when you have what?
Faulty valves that allow back-flow (regurg) or high pressures (stenosis)
26
How can you diagnose A fib on a CVP waveform?
Loss of a A wave and very prominent C wave
27
How can you distinguish between A fib and A flutter on a CVP waveform?
A flutter will look like periods of A fib with periodic cannon A waves
28
Will CVP alone tell you how to proceed with fluid maintenance and replenishment?
NO | CVP is getting a ballpark number for pressure and then up to you as to how to proceed with interventions and treatments
29
In the central line packets, what are suturing needles also called?
K needles
30
Look at the picture of tray contents and be able to recognize and name each
``` EX: J wire Finder needle Catheter Lidocaine ETC ```
31
What is the syringe called that allows you to find the vein and feed the J wire directly through the stopper without ever having to disconnect the syringe from it?
Wire-thru syringe
32
What does the ASK stand for in central line kits?
Arrow select kits
33
What pertinent information is on the outside of the central line kit that you need to check before opening it?
:Flow equivalent lumen :How many lumens :Size of catheter in french :Length of catheter in cm
34
What are 2 most common entry points for insertion of a CVP?
RIght IJ | RIght sub-clavian
35
The velocity of a pressure waveform is roughly equivalent to what?
Speed of sound
36
When placing a mid-RIJ central line, what is the distance to the RA? What size length kit should you use?
20 cm so should use 16cm central line to not fully enter RA
37
What factors are considering when picking out the appropriate sized kit length?
Patients height NOT AGE OR WEIGHT
38
Which lumen is the largest lumen of the central line?
Distal lumen and is usually 14 g
39
T OR F: It is acceptable to release the J wire at any time when placing into the patient?
FALSE | it is never acceptable to release the J wire once it has entered the patient
40
What size are most J wire outer diameter ? What size cannula will this fit through?
0.028 inches J wire | will fit through 18g cannulas
41
For placing a Right IJ cannula, where should the needle be inserted and what should be palpated ?
Should be inserted at the apex of the triangle formed by the 2 heads of the sternocleidomastoid muscle with needle tip directed towards ipsilateral nipple. The carotid artery should be palpated before needle entry
42
What are the anatomical borders of the triangle you shoot for during IJ insertion?
Clavicular head of sternocleidomastoid muscle, sternal head of "" muscle, Clavicle
43
When placing a central line via ultrasound, how do you know which one is the vein on the screen?
The vein is compressible
44
What will help increase the diameter of the IJ for easier placement of central line?
Asking patient to perform Valsalva maneuver
45
What is the largest risk when placing a subclavian vein central line?
Risk of pneumothorax
46
What is different when placing a catheter into EJ?
EJ lies on top of Sternocleidomastoid muscle
47
In the arm, what is the vein of choice when placing a central line?
Basilic vein
48
What mnemonic is used for the femoral vein placement of a central line?
NAVY or NAVAL from lateral to medial (nerve artery vein Y formed by legs) (nerve artery vein air lymph node)
49
What is distance from IJ to RA and PA?
``` RA = 20 cm PA = 45 cm ```
50
What is distance from femoral vein to RA and PA?
``` RA = 40 cm PA = 65 cm ```
51
What is distance from subclavian to RA and PA?
``` RA = 10 cm PA = 40 cm ```
52
The guidewire will always come out what connector?
Distal connector
53
What must always be done to ensure proper placement on a central line and should be included in pre-checklist to do list?
Make sure cap is off the distal connector to allow J wire/guidewire to fully exit connector
54
I not sure how much he could possibly ask about this one, but maybe just be familiar with different parts of kit.
I do hate you all for giving me this subject PS

I & M (37 decks)

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