Flashcards in Hemodynamics Monitoring Deck (24):
Hemodynamic Physical Assessment
JVD, BLE edema, crackles d/t fluid overload
Hemodynamic Non invasive monitoring
MAP, SaO2, EKG, VS
Hemodynamic Invasive monitoring
Arterial line; central venous pressure; swan-ganz catheter
Allen test is done when
q1hr and BEFORE insertion of invasive monitor; hold both ulnar and radial pulse then release ulnar pulse to see if there is enough perfusion with only that artery
Where is Arterial line inserted?
through radial artery
What does Arterial line measure?
MORE ACCURATE MAP than one acquired noninvasively; it constantly measures systolic and diastolic; so we know all organs are getting enough perfusion (kidney needs 60 mmHg)
What intervention with an Arterial line
use heparin to prevent clot in line
Arterial Line PC
loss of tissue s/p infarction
Central Venous Pressure?
measure R ventricular preload (the stretch); the mean pressure at the end of expiration.
Where is Central Venous catheter inserted?
through internal jugular or subclavian vein.
What does Central Venous Pressure dx?
fluid volume problem; the greater the CVP = R ventricular failure or fluid overload; the lower the CVP = hypovolemia
What can Swan Ganz dx?
dx L ventricular failure and mitral valve stenosis for, via L atrial pressure being equal to the pressure at pulmonary artery; can dx pulmonary HTN and pulmonary edema.
How is Swan Ganz Catheter inserted?
via subclavian, 4th intercostal space between sternum and axilla, through R atrium, tricuspid, to R ventricle; inflate the balloon and let float to pulmonary artery to wedge, then deflate balloon
Swan Ganz Catheter PC
DYSRHYTHMIA; then puncture ventricle; can rupture pulmonary artery with balloon; can cause infarction with balloon
Swan Ganz Catheter measures pressures in the
R atria, R ventricle, pulmonary artery pressure = to pressure as L atria
Intervention regarding the transducer r/t Swan Ganz
Keep level to atria of heart; zero to atmospheric pressure; HOB < 45 degrees; don't move it up and down;
why do we do zeroing?
so the monitor reads zero at atmospheric pressure
transducer should be at what level
at phlebostatic axis; level to atria of heart
If the transducer is placed too high
the reading will be low; erroneous reading
if the transducer is placed too low
the reading will be high; erroneous reading
PC of invasive monitoring
erroneous readings; hemorrhage slowly over 3 days, infection, thrombus, neuro impairment, loss of limb; death of tissue; maintenance complications;
Nursing Assessment with invasive monitoring
LOC, color, temp, VS, peripheral pulses, cap refill, UO, hypoactive BS; if pt change position reposition transducer to phlebostatic axis.
Patient teaching for invasive monitoring
don't pull it out