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Hemodynamic monitors and equipment Flashcards

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1
Q

What kind of sounds are being listened for with auscultation method for BP measurement?

A

Korotkoff

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2
Q

Which sounds is SBP and which is DBP with auscultation method?

A

SBP: First sound
DBP: Measured when the last sound dissapears

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3
Q

What is the method that automated NIBP machines use to measure BP?

A

Oscillometric

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4
Q

What is the most accurate measurement from NIBP? SBP DBP or MAP?

A

MAP

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5
Q

Which value for NIBP is most susceptible to error?

A

Diastolic

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6
Q

Will an NIBP work when the patient is on LVAD or Bypass?

A

No! Need pulsatile flow to be able to use a BP cuff

*Aline will still be able to give you a MAP

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7
Q

What is the ideal length and width or the bladder of a BP cuff?

A

Ideal length= 80% of the extremity circumference
Ideal width=40% of the extremity circumference

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8
Q

A cuff that is too small leads to over or under estimation of SBP?

A

Over

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9
Q

A cuff that is too large leads to over or under estimation of SBP?

A

Under

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10
Q

What happens to your BP reading as you move from the aortic root towards the periphery

A

SBP increases
DBP decreases
PP widens

MAP remains constant!

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11
Q

How does the dicrotic notch change in position the further away the monitoring site is from the heart?

A

Dicrotic notch moves further away from the systolic peak the further the monitoring site is from the heart

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12
Q

BP is affected by gravity. If BP cuff location is above the heart, the BP reading will be falsely increased or decreased?

A

Decreased

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13
Q

BP is affected by gravity. If BP cuff location is below the heart, the BP reading will be falsely increased or decreased?

A

Increased

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14
Q

For every 1 inch change in where you are monitoring BP in relation to the heart, how much does BP change by?

A

2 mmHg

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15
Q

If lymph nodes have been removed on arm same side you are planning to put your BP cuff on, what should you do?

A

Do NOT place cuff on that side, use the other

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16
Q

Closure of aortic valve is represented by what on the a line waveform?

A

Dicrotic notch

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17
Q

What level should transducer be with a line?

A

Level of the right atrium

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18
Q

If you want to measure CPP, where can you place the transducer of a line?

A

External auditory meatus

(corresponds with the COW)

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19
Q

How many oscillations does it take to re-establish baseline after the Flush test with an a line if optimally damped?

A

1

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20
Q

How many oscillations does it take to re-establish baseline after the Flush test with an a line if under damped?

A

Several

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21
Q

How many oscillations does it take to re-establish baseline after the Flush test with an a line if over damped?

A

None

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22
Q

With under damped waveform, are SBP DBP and MAP under or over estimated?

A

SBP- over
DBP- under
MAP- accurate

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23
Q

With over damped waveform, are SBP DBP and MAP under or over estimated?

A

SBP- under
DBP- over
MAP- accurate

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24
Q

The tip of the CVP catheter should rest just above what structure?

A

The junction of the vena cava and the RA.

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25
Where should the tip of the PA catheter reside?
In the pulmonary artery, distal to the pulmonic valve (25-35 cm from the VC junction)
26
If you are inserting a subclavian CVC, what is the distance from the insertion site to the vena cava & right atrial junction?
10 cm
27
If inserting a Right IJ CVC, what is the distance from the insertion site to the vena cava & right atrial junction?
15 cm
28
If you are inserting Left IJ CVC, what is the distance from the insertion site to the vena cava & right atrial junction?
20 cm
29
If you are inserting a femoral CVC (either side), what is the distance from the insertion site to the vena cava & right atrial junction?
40 cm
30
If you have a CVC in place, what is the distance to the right atrium from the VC & right atrial junction to the catheter tip?
0-10 cm
31
If you have a CVC in place, what is the distance to the right ventricle from the VC & right atrial junction to the catheter tip?
10-15 cm
32
If you have a CVC in place, what is the distance to the pulmonary artery from the VC & right atrial junction to the catheter tip?
15-30 cm
33
If you have a CVC in place, what is the distance to the PAOP position from the VC & right atrial junction to the catheter tip?
25-35 cm
34
What is the most common complication while obtaining access with a PA catheter?
Dysrhythmias
35
Why would you not want to float a Pulmonary Artery Catheter in the patient with a left bundle branch block?
Advancing the catheter into the RV can cause a RBBB Which can put the patient in complete heart block
36
What is the classic representation of pulmonary artery rupture?
Hemoptysis
37
What mechanical event correlates with the "a" portion of the CVP waveform?
RA contraction
38
What mechanical event correlates with the "c" portion of the CVP waveform?
Tricuspid valve elevation into RA
39
What mechanical event correlates with the "x" portion of the CVP waveform?
Downward movement of contracting RV
40
What mechanical event correlates with the "v" portion of the CVP waveform?
RA passive filling
41
What mechanical event correlates with the "y" portion of the CVP waveform?
RA empties through open tricuspid valve
42
Electrical event associated with A wave
Just after P wave (atrial depolarization)
43
Electrical event associated with C wave
Just after QRS complex (ventricular depolarization)
44
Electrical event associated with X descent
ST segment
45
Electrical event associated with V wave
Just after T wave begins (ventricular depolarization)
46
Electrical event associated with Y wave
After T wave ends
47
Where is the phlebostatic axis?
4th ICS mid anteroposterior level
48
If transducer is above the zero point, what does that do to CVP reading?
Underestimates it
49
If transducer is below the zero point, what does that do to CVP reading?
Overestimates it
50
51
At what point in the respiratory cycle should CVP be measured?
end-expiration
52
Normal CVP
1-10 mmHg
53
Why would there be a loss of an a wave on CVP?
A fib V pacing if the underlying rhythm is asystole
54
What does a large a wave on CVP waveform mean?
Atrium contracts and empties against a high resistance (either at a valve or non compliant ventricle)
55
Why may a large v wave be seen?
Tricuspid regurgitation Acute increase in intravascular volume RV papillary muscle ischemia mem
56
What causes the a wave on PAOP?
Left atrial systole
57
What causes the c wave on PAOP?
Mitral valve elevation into the LA during LV systole (isovolumetric contraction)
58
What causes the v wave on PAOP wave form?
passive left atrial filling
59
Which zone should tip of PAC be placed?
Zone 3
60
What is the order of pressures in Zone 3?
Pa > Pv > Palveolus
61
Zone 3 is the dependent region of the lung. Where is that when sitting? Supine? Prone? Lateral?
Sitting: At the lung base Supine: Towards the back Prone: Towards the chest Lateral: Towards the dependent (lower) lung
62
How can you tell the tip of pulm art cath is not in zone 3?
PAOP > pulm artery end diastolic pressure Nonphaseic PAOP tracing Inability to aspirate blood from the distal port when the balloon is in the wedged position
63
What are some things that would make PAOP not accurately reflect LVEDV?
Impaired LV compliance Mitral valve dz (stenosis or regurg) L -> R cardiac shunt Tachycardia PPV PEEP COPD Pulmonary hypertension Non West Zone 3 placement of PAC
64
Aortic valve insufficiency causes PAOP to over or under estimate LVEDV?
Under
65
What is the most common way we measure CO using a PA cath?
Thermodilution
66
How to perform thermodilution test with PA catheter:
Inject 5% Dextrose or 0.9% NaCl of known quantity and temp through PROXIMAL port of PAC Each injection should occur during the same phase of the respiratory cycle and be completed in less than 4 seconds. *Avg 3 seperate injections to get an accurate CO
67
When looking at the computer generated curve for thermodilution CO, is more area under the curve indicative of high or low CO?
Low *There is an inverse relationship b/w the 2
68
Does the following factor over or under estimate CO? Injecting a volume too high
Underestimates CO
69
Does the following factor over or under estimate CO? Injecting a solution that is too cold
Underestimates CO
70
Does the following factor over or under estimate CO? Injecting volume that is too low
Over
71
Does the following factor over or under estimate CO? Injecting a solution that is too hot
Over
72
Does the following factor over or under estimate CO? Partially wedged PAC
Over
73
Does the following factor over or under estimate CO? Thrombus on tip of PAC
Over
74
Does the following factor over or under estimate CO? Or make it unable to predict Intracardiac shunt
Unable to predict
75
Does the following factor over or under estimate CO? Tricuspid regurg
Unable to predict
76
What is the issue with using continuous CO monitoring compared to thermodilution?
Continuous is delayed. It averages the previous 3-6 min values
77
Normal mixed venous oxygen saturation:
65-75%
78
Mixed venous oxygen saturation is an indirect monitor of __
CO
79
What is the equation for mixed venous oxygen saturation?
SvO2= SaO2 - (VO2/Q x 1.34 x. Hgb x 10)
80
Does sepsis increase or decrease SvO2?
Increase
81
Does impaired oxygen uptake by the tissues increase or decrease SvO2? What is an example?
Increase Cyanide poisoning from Na Nitroprusside is the classic example
82
Does right to left shunt sepsis increase or decrease SvO2?
Increase Oxygenated blood travels from the left heart to the right heart and is added to pulmonary venous blood
83
Where is a true mixed venous sample obtained from?
Blood returning from the SVC, IVC, and coronary sinus. Mixing of blood from these 3 sources occurs in the pulmonary artery, thus a PAC is required to measure SvO2.
84
Where should the tip of the esophageal doppler sit?
~35 cm from the incisors (T5-T6)
85
What are some things that can produce error when using the esophageal Doppler?
Aortic stenosis Aortic insufficeincy Disease of the thoracic aorta Aortic x clamp After CPB Pregnancy
86
Relative contraindication to esophageal doppler?
Varices

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