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Basics > Invasive monitoring > Flashcards

Invasive monitoring Flashcards

1
Q

When deciding whether to use a CVC?

A

1- patient condition, disease severity
2- procedure, magnitude of surgery
3- practice setting

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2
Q

Practical considerations with CVC

A
  • what hemodynamic info do we need?? L and R side of heart??
  • IV access needed?
  • TPN, pressors??
  • VAE risk
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3
Q

Recommendations for PAC

A
  • known CV disease
  • XC of thoracic or abdominal aorta
  • resp failure
  • known or suspected PE
  • hx of cardiac surgery
  • pneumonectomy
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4
Q

Recommendations for PAC cont.

A
  • anticipated fluid shifts
  • sepsis
  • inotropes or vasodilators
  • pulm HTN
  • cor pulmonale
  • treated with bleomycin - pulm fibrosis
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5
Q

Recommendations for PAC

EF

A

<2.1L/min/m2
indicates CHF
normal EF 60%

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6
Q

Internal jugular CVC risks

A
  • VAE
  • pneumo possible on LIJ
  • thoracic duct injury - left side
  • carotid puncture
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7
Q

5 acceptable sites for inserting a PAC

A 
1- Right IJ 
2- external jugular 
3- femoral 
4- subclavian 
5- basilic- hardest!!
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8
Q

Positioning tip of CVP

A

just above junction of the SVC and RA
3-5cm outside of RA
below clavicles at the 4th thoracic vertebra

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9
Q

2 reasons why PA cath not reaching PA

A
  • perforation

- coiling

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10
Q

Positioning tip of PAC (Right IJ)

- RA distance and pressure

A

18-22cm

6-8 torr

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11
Q

Positioning tip of PAC (Right IJ)

- RV distance and pressure

A

28-32cm

25/0

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12
Q

Positioning tip of PAC (Right IJ)

- PA distance and pressure

A

40-50cm

25/12

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13
Q

Positioning tip of PAC (Right IJ)

- PA wedge distance and pressure

A

45-50cm

2-12

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14
Q

CVC complication

- pneumo

A

0-15% chance

can occur after a negative CXR (N2O)

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15
Q

Most common complication of CVC

A

infection

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16
Q

most common PAC complication

A

ventricular ectopy- usually self limiting

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17
Q

Most severe PAC complication

A

PA rupture

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18
Q

PA rupture treatment

A
  • LLD position (left lateral decubitus)
  • position with bleeding lung down (dependent)
  • isolate lung with dual lumen ETT
  • reverse anticoagulation
  • PEEP
  • Volume resuscitation
  • surgery for thoracotomy
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19
Q

When do you want to place A-line on RIGHT side only??

A
  • thoracic aneurysm
  • mediastinoscopy
  • in Open heart if left internal mammary is harvested for bypass.
20
Q

6 factors that can contribute to A-line thrombosis

A 
1- prolonged duration 
2- catheter size (18G vs 20G)
3- catheter material (Teflon less thrombogenic) 
4- proximal emboli
5- prolonged shock 
6- pre existing vascular disease
21
Q

what is the most commonly used PA catheter size

A

7 french

22
Q

what is the balloon capacity of a #5 PAC

A

1.5cc

23
Q

Diastole

A

opening of tricuspid and bicuspid valves

24
Q

Systole

A

closing of tri and bicuspid valves

25
Q

Right ventricular waveform

A
  • observed only at the passage of a PAC
  • often accompanied by ectopy
  • RVEDP measured at R wave
  • normal RV pressure = 15-30/0-8 torr***
26
Q

LV waveform

A

seen during left heart cath
normal LV pressure 100-140/0-12 torr***
LVEDP measured at R wave

27
Q

PA waveform

A
  • normal 15-30/4-12 torr

- PAD in normal pts can be used as alternative to PAOP to estimate LVEDP

28
Q

Systemic arterial waveform (a-line) waveform

A

morphology similar to PA waveform

dicrotic notch due to Aortic valve closing

29
Q

Atrial pressure waveform analysis: 5 components, 3 waves

A
  • A wave: atrial contraction
  • C wave: closure of tricuspid valve and isovolumetric contraction
  • V wave: venous filling in atria
30
Q

Normal RAP

A

1-8 torr

31
Q

3 causes of increased CVP

A

1- pulmonary HTN
2- right heart failure
3- left heart failure

32
Q

cause of decreased CVP

A

hypovolemia

33
Q

EARLY clinical signs of increased CVP

A
  • distended peripheral veins
  • increased right sided filling pressures
  • increased HR
  • bounding pulses
34
Q

LATE signs of increased CVP

A
  • systemic edema
  • decreased pulmonary compliance
  • S3 gallop
35
Q

PAOP - normal LAP____

PAOP _____

A

2-12 torr LAP

5-15 torr PAOP

36
Q

Cardiac output

A

SV x HR

37
Q

CO thermodilution

A

the change in temp of blood is inversely proportional to blood flow
- if erroneously low volume of injectate will have false high CO

38
Q

CO- regurgitation of tricuspid or pulmonic valve or septal defect may lead to….

A

falsely high TD CO readings

39
Q

_____ can cause interference with TD CO

A

electrocautery

40
Q

CO accuracy can be increased by…

A

1- averaging at least 3 measurements
2- measure at end inspiration or expiration
3- injecting identical volume and rate of NS

41
Q

Cardiac index

A

CO/BSA (m2)

normal - 2.5- 4.0L/min/m2

42
Q

SVI

A

SV/BSA

normal = 40-60

43
Q

normal SV for 70kg male

A

60-90ml

44
Q

EF

A

SV/EDV
normal 55-75%
EF <40 = LV failure

45
Q

PAOP > LVEDP

A
  • mitral stenosis
  • left atrial myxoma (tumor)
  • pulm venous obstruction
  • elevated alveolar pressure
46
Q

PAOP <LVEDP

A
  • decreased LV compliance

- aortic insufficiency

Basics (9 decks)

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