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Hemodynamic monitoring Flashcards

1
Q

What is the ideal length of the bladder size of a BP cuff? Width?

A

Length - 80%
Width - 40%

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2
Q

If the cuff is too small, what will the BP read?

A

Overestimates because it takes more pressure

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3
Q

If the cuff is too large, what will the BP read?

A

Underestimates because it takes less pressure

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4
Q

Where is the widest pulse pressure when measuring BP?

A

Foot

SBP is the highest
DBP is the lowest

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5
Q

Where is the narrowest pulse pressure when measuring BP?

A

Aortic root

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6
Q

If the BP cuff is above the heart, the BP reading will be;

A

Falsely decreased

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7
Q

If the BP cuff is below the heart, the BP reading will be;

A

Falsely increased

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8
Q

Over dampened or under dampened? SPB is overestimated and DPB is underestimated?

A

Under dampened

** many oscillations

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9
Q

What causes an under dampened art line?

A

Stiff, non compliant tubing

Catheter whip

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10
Q

Over dampened or under dampened? SPB is underestimated and DPB is overestimated?

A

Over dampened

** no oscillations

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11
Q

What causes an over dampened art line?

A

Air bubble
Clot
Low pressure bag pressure
Kinks
Loose connection

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12
Q

Is the MAP accurate with an over or under dampened art line?

A

YES

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13
Q

How far should a central line be advanced through the R IJ to achieve correct placement?

A

15 cm

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14
Q

What is at increased risk when placing a Left central line?

A

Puncturing the thoracic duct

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15
Q

When are dysrhythmias most common to occur? Treatment?

A

While obtaining access

Pull back

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16
Q

When does the indcidence of infection increase?

A

After three days

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17
Q

When shouldn’t you float a PAC?

A

A patient with a LBB because it floating the PAC may trigger a RBB which would put the patient into complete heart block

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18
Q

What is the classic presentation for pulmonary artery rupture?

A

Hemoptysis

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19
Q

What increases the risk of a pulmonary rupture?

A

Anticoagulation
Hypothermia
Advanced age

Using liquid in the balloon
Chronic inflation of balloon
Unrecognized wedging

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20
Q

Distances of catheter insertion ***

A
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21
Q

What is the A wave on the cvp pressure waveform?

A

RA contraction

First upstroke

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22
Q

What is the c wave on the cvp pressure waveform?

A

Tricuspid closure - RV contraction

Second upstroke

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23
Q

What is the x wave on the cvp pressure waveform?

A

RA relaxation

first major downslope

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24
Q

What is the v wave on the cvp pressure waveform?

A

Ra passive filling

25
What is the y wave on the cvp pressure waveform?
RA empties into RV through open tricuspid valve
26
What increases RA pressures
Low transducer Hypervolemia Tricuspid stenosis or regug VSD PEEP Tamponade Constrictive pericarditis RV failure Pulmonic stenosis
27
When should CVP be measured? Where?
End expiration 4th intercostal space, mid anteroposterior level
28
What is a normal CVP?
1-10
29
What is CVP measurement a function of?
Intravascular volume Venous tone RV compliance
30
Factors that decrease CVP?
High transducer Hypovolemia
31
When is the a wave lost on a CVP?
Afib V pacing if the underlying rhythm is asystole
32
What increases the amplitude of the a wave on the CVP?
Tricuspid stenosis Diastolic dysfunction myocardial ischemia Lung disease AV dissociation Junctional rhythm V pacing - asynchronous PVCs
33
What causes a large V wave?
Tricuspid regurg Acute increase in volume RV papillary muscle ischemia
34
What changes do you see when the PA catheter enters the RV?
Systolic pressure increases Diastolic is equal to CVP
35
What changes do you see when the PA catheter enters the Pulmonary artery?
Systolic stays the same Diastolic pressure rises Dicrotic notch is seen
36
What changes do you see when the PA is wedged?
Same waveform as the CVP but with the L side of the heart
37
What are the pressures in the RVP?
15-30 0-8
38
What are the pressures in the PAP
25/10
39
What are the pressures in the PAOP (wedge)
5-15
40
Which lung zone should the tip of the PA catheter be in?
Zone 3
41
What suggests the PA tip is not in zone 3?
Can't draw blood because it is wedged Nonphaseic PAOP tracing PAOP > PA end diastolic
42
What causes PAOP to underestimate LVEDV?
aortic valve insufficiency
43
What causes PAOP to overestimate LVEDV?
Everything but aortic valve insufficiency and correct placement
44
Which situation underestimates cardiac output obtained by thermodilution ?
High injectate volume or cold
45
When can thermodilution not predict ?
Intracardiac shunt Tricuspid regurgitation
46
Where and how should the thermodilution be administered?
5% dextrose or NS through the proximal port in under 4 seconds
47
When should thermodilution be used versus continuous cardiac output?
in unstable patients
48
Why is a PA catheter necessary to measure SvO2?
Need a collection of all venous blood SVC IVC Coronary sinus
49
What is a normal SvO2? What is needed to measure?
65-75% CO VO2 Hgb SaO2
50
What is pulse contour analysis? How does it work?
Indicator on how the patient will respond to a 250mL bolus of fluid Measures the stroke volume variation during the respiratory cycle or the change in intrathoracic pressure
51
If the SVV is >13% will the patient respond to a 250mL bolus? <13%?
yes they will respond if the SVV is > than 13%
52
What limits the use of SVV?
Spontaneous Ventilation PEEP Dysrhythmias Open chest RV dysfunction Small Tv
53
What are contraindications to using esophageal doppler?
Esophageal disease
54
How much will the BP change for every 10cm? every inch?
10cm - 7.5mm Inch - 2mm
55
What does the upstroke on an Aline tell you?
the contractility
56
What does the dicrotic notch tell you on an Aline?
closure of the Aortic valve
57
How is the pulse pressure calculated on an Aline?
Peak - trough
58
How does the cvp waveform correlate to the electrical activity of the heart
59

Monitoring (10 decks)

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