Hemodynamic monitoring Flashcards
(49 cards)
What location is the transducer placed for arterial line monitoring?
Phlebostatic axis, 4th intercostal midaxillary
What benefits do arterial lines serve over the NIBP?
Second by second reading
Able to obtain arterial blood samples
What does the dicrotic notch signify on an arterial line wave form?
Aortic valve closes (diastolic phase)
How do you “zero” the transducer?
Place transducer at phlebostatic axis, making sure no air bubbles
Turn the stop cock off to the patient and remove cap if needed
Press “zero” on monitor
Replace cap on transducer
Turn stopcock back on to the patient
How many oscillations should you see before returning to wave form?
No more or no less than 3 oscillations
If you see none, overdamping
If you see over 5, underdamping
How many ML an hour is delivered of normal saline Heparin infused saline with an ART line?
3 ml/hr
What are 3 common causes of an overdamped ART line waveform?
Kinked line
Air in line
Pressure bag overfilled
What does overdamping mean?
Too much pressure
Wave form will look more like rounded tops with no dicrotic notch
What does underdamping mean?
Too little pressure
Wave form will be sharp peaks with dicrotic notch lower on the down slope
What are 2 common causes of an underdamped ART line waveform?
Pressure bag not full
Noncompliant tubing
Air in line
What does the saline bag need to be pressurized at for an ART line?
300 mmhg with a pressure bag
What are some benefits of a central venous line?
Rapid fluid replacement
Medication administration
Rapid access to central circulation
Used for hemodynamic monitoring
What are we measuring with central Line?
Preload
What are we measuring with a swan-ganz catheter (pulmonary artery catheter)?
Right heart preload
Right heart afterload
Left heart preload
How many ML of air is used to inflate the distal tip of the balloon in a Swanz-Ganz line?
No more than 1.5 cc of air
While obtaining a pulmonary capillary wedge pressure (PCWP), do not leave balloon inflated longer than how many seconds and how many breaths?
No more than 15 seconds and no more than 3 breaths.
When should you take a reading off the PA catheter?
At the end of exhalation.
Can you use the PA line for fluid or medication administration?
No, it is for monitoring and lab samples only. Use the proximal port for infusions and fluid.
Should you keep the balloon inflated with a PA catheter while transporting? Why or why not?
No, you should deflate the balloon to prevent an inadvertent wedge pressure. Balloon size increases at altitude.
If the diacrotic notch is on the left side of the waveform, what does this indicate?
Right ventricle waveform (tricuspid valve closing)
If the dicrotic notch is on the right side of the waveform, what does this indicate?
Pulmonary artery waveform (pulmonic valve closing)
What is the progression of the Swan-Ganz catheter through the heart?
Pass through the right atrium
Into the right Ventricle
Final destination is Pulmonary Artery
Balloon inflated to get wedge pressure.
What is a normal Central Venous Pressure (CVP or RAP)?
2-6 mmHg and measures right heart preload
What is a normal right ventricular Pressure (RV or RVP)?
Systolic 15-25 mmHg
Diastolic 0-5 mmHg
