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Invasive Monitoring Flashcards

1
Q

What does Hypothermia does to latency?

What does Hyperthermia does to amplitude?

A

◦ Hypothermia increases latency
◦ Hyperthermia decreases amplitude

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2
Q
A
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3
Q

What does SSEP tests monitors?

A

SSEP tests only motors dorsal column (Sensory)

NOT MOTOR

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4
Q

Distance to the junction of vena cava and right atrium from cannulation Sites

What are the distances in cm?

Subclavian

Right / Lef IJ

Femoral

Right / left median basilic

A

How much is one marking?

10

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5
Q

What CVP waveform would represent diastole?

Where is the start of systole?

A

The Y descent probably will be dominant in diastole

The A waveform is the start of systole

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6
Q

What type of CVP waveform will you see in tricuspid regurgitation?

A

The right atrium gains volume during systole - so the “c” and “v” wave is much higher

The right atrium “sees” right ventricular pressures and the pressure curve becomes “ventricularized”

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7
Q

What does an overdamped system means?

What does it overestimate?

What does it underestimate?

A

Overdamped system: settles to baseline slowly without oscillating
– Underestimates the systolic and overestimates the diastolic

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8
Q

You expect your arterial system to be overdamped, what do you expect your map to be?

What if your system is underdamped?

A

with both systems, MAP is usually accurate

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9
Q

SSEP (Somatosensory evoked potentials)

What does it reflect?

A
  • SSEP (somatosensory evoked potentials): electrophysiologic responses of nervous system to the application of discrete stimulus at a peripheral nerve anywhere in the body
  • SSEP’s reflect the ability of a specific neural pathway to conduct an electrical signal from the periphery to the cerebral cortex
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10
Q

Central Venous Anatomy

What do we worry about when cannulting a patient?

A

We worry about accidentally puncturing the apex of the lungs

  • that can lead to pneumothorax

- always ASPIRATE when putting a needle in

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11
Q

Absence of an A wave on the CVP waveform might mean?

A

AFIB

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12
Q

Hemothorax happens in what approach?

what causes this?

A

Hemothorax with subclavian approach due to subclavian artery laceration

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13
Q

A short time in diastole such as in tachycardia may cause?

it may also cause what waves to merge?

A

short “y” descent

tachycardia can make “v” and “a” waves to appear to merge

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14
Q

Identify the relation between the a line waveform and the EKG

A
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15
Q

what complication do we worry about with IJ approach?

A

CAROTID PUNCTURE

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16
Q

What happens to the CVP waveform on cardiac tamponade?

A
  • CVP becomes monophasic with a single, prominent “x” descent with a muted “y” descent
  • Similar to pericardial constriction but not exactly the same
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17
Q

Where do we measure the CVP monitoring?

why?

What is the normal range?

A

The CVP monitoring is measured at the level of tricuspid valve

At this level, hydrostatic pressures caused by

changes in body position almost zero

Normal 1- 15 mmHg

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18
Q

most common cannulation sites of thr areterial line

19
Q

What cvp waveform will you associate with a junctional rhythm?

A

LARGE/ CANNON “A” wave

–> also seen with A-V dissociation , ventricular pacing

20
Q

What does 50% or greater decrease in amplitude may indicate in SSEP monitoring?

A

Amplitude: measured from baseline to peak. Any decrease in amplitude (50% OR greater) may indicate disruption of the sensory nerve pathways.

21
Q

What does the A wave represent?

What does the Y descent represent?

What does the V wave represent?

A

Waveforms:
– A wave: follows p wave on EKG

  • – Due to atrial contraction
  • – Absent in Afib and exaggerated in junctional rhythms

– C wave: due to triscuspid valve elevation during early

ventricular contraction

– X wave: reflects right ventricular ejection, which causes an emptying of blood from the ventricle and a sharp decrease in pressure

– V wave: reflects venous return against a closed triscuspid valve

– Y wave: reflects triscuspid valve opening, causing blood flow into the ventricle and a decrease in pressure in the right atrium

22
Q

GIANT V wave that replaces normal c,x,v may mean?

A

TRICUSPID REGURGITATION

23
Q

What is the most common complication that we see with a subclavian and low anterior IJ approach?

A

Pneumothorax

24
Q

Where does the motor pathway’s get its blood supply

How about the sensory pathway?

A
  • *Motor** pathways: blood supply from anterior spinal artery
  • *Sensory pathways:** blood supply from posterior spinal artery
25
What **complication** do we worry about with a **left IJ site? why?**
**Thoracic duct puncture** Thoracic duct wraps around Ij as high as 3-4 cm above the sternal end of clavicle
26
What changes in **latency indicates a disruption of the sensory pathway?**
***Latency:*** time from onset of stimulus to occurrence of a peak. **Any increase in latency (10% or greater)** may **indicate disruption of the sensory nerve pathways.**
27
How long can the s**pinal cord tolerate ischemia** before we **lose SSEPs?**
The **SPINAL CORD** can tolerate **ISCHEMIA for 20** minutes before **SSEP’s are lost**
28
What does these arterial waveforms represent slope of upstroke --\> Respiratory variations --\> Slope of downstroke --\> Dicrotic notch --\>
**Arterial** **upstroke** represents **myocardial contactility** **respiratory variations** --\> large **variations** maybe indicative of **hypovolemia** Slope of **downstroke--\> SVR** **Dicrotic Notch --\> AV closure**
29
What causes **decreases** in **Amplitude?**
**Hypoxia** **Hypotension** **Anemia if Hct \<10% --\>** decreased amplitude (probably R/T tissue hypoxia)
30
What causes an **INCREASE** in **Latency?**
**Hypothermia** **Hypocarbia** --\> increased latency with ***ETCO2 \<25*** **Anemia if Hct \<15%**
31
What can Bradycardia do to your CVP waveforms?
**Causes each wave to become more distinct** **"h" wave may become evident -- plateau wave in mid or late diastole**
32
**PAP monitoring** What are the distances from the right IJV to the distal cardiac and pulmonary structure?
33
What is the **most life-threatening** complication of **PAP insertion?**
**PA RUPTURE**
34
What does an **underdamped** system represent? What does it **overestimate**? What does it **underestimate**?
**Underdamped system:** continues to oscillate for **3-4 cycles** – **Overestimates** the systolic and **underestimates** the **diasolic BP**
35
What is the **leading complication** of placing **PAP catheters?**
**Catheter-related bloodstream infection** (CRBSI) ranks as third most common nosocomial infection in ICU’s
36
A **short PR i**nterval can cause? **tachycardia**
* **"a" and "c"** waves to **fuse** * **short y descent** [shorten time spent in diastole] * **v and a waves** appear to **merge**
37
What do you expect the waveform of an arterial line of a patient that has a **low EF ?**
**Slurred upstroke** - patient that has a **low contractility**
38
What does **VAA do** to **amplitude** and **latency?**
* **All VAA cause dose-dependent decreases in amplitude and increases in latency** * The above can be worsened with the addition of N2O * If possible, bolus injections of drugs should be avoided, especially during critical stages of surgery * Continuous infusions are preferable
39
What would you expect to see on the arterial waveform of a patient on hypertensive crisis?
**Slurred downstroke** --\> indicative of **increased SVR/ afterload**
40
This is **inline** with your **thumb?** Where do **arteries anastamose?**
**Radial Artery** **Arteries anastamose via 4 arches in the hadn and wrist (superfcial and deep parmal arches)**
41
What **CVP** waveform do you see in **tricuspid stenosis**?
* Mean **CVP is elevated** * **“a” wave** is usually **prominent** as it tries to overcome the barrier to emptying * **“y” descent muted** as a result of decreased outflow from atrium to ventricle
42
What **type of waveform** would I expect as the site of cannulation moves from the aorta peripherally to the arterial trea? What causes the **pressure changes?** How **much would the SBP in the radial artery compared to the pressure of aorta?**
**exaggerated waveform** Pressure changes **result from decrease in arterial wall compliance and from resonance** **SBP in radial** aretery may be as much as **20-50**
43
What are the Normal Pressure ranges? Right Atrial CVP Right Ventricle

Principles in Practice (19 decks)

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