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Summer 2020 - Advanced Anesthesia - CV > Monitoring the CV Patient - Quiz 2 > Flashcards

Monitoring the CV Patient - Quiz 2 Flashcards

1
Q

Why are A-Lines used?

A
  • Real time BP
  • Frequent Blood Draws
  • Bypass, IABP, Vasoactive Drugs, Deliberate Hypotension
  • Cant do NIBP d/t burns, obesity
  • Pulse Contour Analysis: SPV, SV
  • Easy to place
  • Hand has good collateral circulation
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2
Q

What are the complications to placing a Radial Art Line?

A

Vasospastic Disease

Prolonged Shock

High-Dose Pressors

Prolonged Cannulation

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3
Q

Why is a Brachial Art Line NOT preferred over a Radial Art Line?

A

Needs longer catheter to get around elbow

Arm needs to stay extended

Collateral circulation not as good as hand

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4
Q

What technique should be used for placing a Femoral Arterial Line?

A

Guide-Wire Technique

Poke Fem artery below Inguinal Ligament

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5
Q

What amount of Systolic Pressure Variation indicates Hypovolemia?

A

> 15 mmHg or Δdown 15 mmHg

(Δdown 5 mmHg = ↓venous return)

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6
Q

What does the PulseCO system do?

A

Predicts increase in stroke volume from fluids and helps identify Hypovolemia

Similar to Echo preload numbers

Needs mech. vent & limited by arrythmias

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7
Q

When is a Central Line indicated?

A

CVP

Advanced CV Disease

Major Operation

Secure Vascular Access

Craniotomy Air Aspiration

Cant get Peripheral

Swanz, Pacer

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8
Q

Where is the Internal Jugular Vein located?

A

Between Sternal & Clavicular heads of Sternocleidomastoid muscle, Anterior to the Carotid

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9
Q

What is used in the Seldinger Method of inserting a CVC?

A

22G Finder

18G Needle

Guidewire

Scalpel

Dilator

Catheter

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10
Q

Where should the needle be inserted when placing a CVC?

A

Towards Ipsilateral Nipple

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11
Q

When placing a CVC, why is the Subclavian sometimes placed instead of an IJ?

A

C-Spine Precautions

Better Patient Comfort

2% Pneumo Risk

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12
Q

What is are the advantages of gaining an External Jugular access?

A

Easy & No Pneumo Risk

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13
Q

What are the complications of Double cannulating the same vein?

A

Vein Avulsion

Tangled Catheter

Catheter Fracture

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14
Q

When should CVP be measured?

A

End-Expiration

(Zero @ Mid-Axillary)

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15
Q

What can a Pulmonary Artery Catheter measure?

A

CO

PAP

PCWP

CVP

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16
Q

What are complications associated w/ Pulmonary Artery Catheters?

A

Serious: Knotting, Pulm. Infarction, PA Rupture d/t overwedge, Endocarditis

Transient RBBB

Dont Place with LBBB

Death

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17
Q

Cardiac Output from a Pulm. Artery Catheter allows for calculation of ____________

A

Cardiac Output from a Pulm. Artery Catheter allows for calculation of Oxygen Delivery (DO2)

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18
Q

How is Thermodilution done?

A
  1. Inject 10cc of room temp/iced D5W into CVP port at End Expiration
  2. Measure change in blood temp at thermistor
  3. Average of 3 Measures
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19
Q

With Thermodilution, Cardiac Output is _______ proportional to area under curve

A

With Thermodilution, Cardiac Output is Inversely proportional to area under curve

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20
Q

What are some problems with measuring Cardiac Output w/ a PA Cath?

A

Inaccurate temps d/t:

Thermistor Blood Clot

Shunts

Tricuspid Regurg

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21
Q

What can be used as an Indirect Cardiac Output indicator?

A

SvO2 if O2, VO2 & Hg are constant

Normal SvO2 60-75%

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22
Q

What can cause and Increased SvO2?

A

Wedged PAC - LAP Saturation

Low VO2 d/t Hypothermia, General Anesthesia, NMB

Carbon Monoxide poisoning

High CO d/t Sepsis, Burn, L-to-R Shunt, AV Fistulas

23
Q

What can cause a Decreased SvO2?

A

Decreased CO

↓Hgb

↓SaO2

↑VO2
(Fever, Agitation, Thyrotoxic, Shivering)

24
Q

What does the dicrotic notch on an A Line tracing signify?

A

Aortic Valve Closure

25
Q

How does an Overdamped A - Line affect the reading?

A

Understimated SBP & Overestimated DBP

26
Q

What does and Underdamped A - Line mean?

A

Overestimated SBP & Underestimated DBP

27
Q

In regards to Square Testing an A-Line, what indicates Optimal Dampening, Overdampening, and Underdampening?

A

Optimal: 1-2 oscillations after square

Underdamped: > 2 oscillations

Overdamped: < 1.5 oscillations

28
Q

What factors might cause an Overdampened A-Line?

A

Bubbles or Clots in Tubing

Vasospasm

Friction

Long, Narrow Tubing Extension

Compliant tubing

29
Q

What factors cause an Under Dampened A-Line?

A

Catheter Whip

Artifact

Stiff Non-Compliant Tubing

Hypothermia

Tachycardia

Dysrhythmia

30
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Subclavian?

A

10 cm

31
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Right IJ?

A

15 cm

32
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Left IJ?

A

20 cm

33
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Femoral Vein?

A

40 cm

34
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Right Median Basilic Vein?

A

40 cm

35
Q

What is the distance to the Vena Cava / RA Junction when placing a CVC from the Left Median Basilic Vein?

A

50 cm

36
Q

When inserting a PA Cath from the RIJ, what is the distance the cathether traveled when it is in the Right Atrium?

A

15 -25 cm

37
Q

When inserting a PA Cath from the RIJ, what is the distance the cathether traveled when it is in the Right Ventricle?

A

25 - 35 cm

38
Q

When inserting a PA Cath from the RIJ, what is the distance the cathether traveled when it is in the Pulmonary Artery?

A

35 - 45 cm

39
Q

When inserting a PA Cath from the RIJ, what is the distance the cathether traveled when it is in the Pulmonary Artery Wedge Position?

A

40 - 50 cm

40
Q

What do the A, C, and V waves represent on a CVP tracing?

A

A Wave: Right Atrial Contraction

C Wave: Closure of Tricuspid

V Wave: Right Atrial Filling

41
Q

When would you see only V Waves on a CVP tracing?

A

A-Fib & Asystolic Ventricular Pacing

42
Q

What would cause Large A Waves on a CVP tracing?

A

Tricuspid/Mitral Regurg

&

Acute Intravascular Volume Increase

43
Q

When would you see Giant, “Cannon” A Waves on a CVP tracing?

A

Junctional Rhythm

Complete Block

PVCs

Ventricular Pacing

Tricuspid/Mitral Stenosis

Diastolic Dysfunction

Myocaradial Ischemia

Ventricular Hypertrophy

44
Q

What can cause a High variation in CVP?

A

RV Failure

Tricuspid Stenosis/Regurg

Cardiac Tamponade

Pericarditis

Volume Overload

Pulmonary HTN

45
Q

What can cause Low CVP Variations?

A

Hypovolemia & ARDS

46
Q

What can cause Overestimates w/ Thermodilution?

A

Low Injectate Volume

Injectate too warm

Thombus on Thermistor

Wedged PA Cath

47
Q

What can cause Underestimates w/ Thermodilution?

A

Excessive Injectate Volume

&

Injectate to Cold

48
Q

What is the PA Wedge Pressure used for?

A

Estimate Left Ventricular End Diastolic Pressure (LVEDP)

Normal: 8 - 12 mmHg

49
Q

List where the PA Catheter is (1-4)

A
  1. Right Atrium: 0-8mmHg
  2. Right Venticule: 20-30/0-8mmHg
  3. Pulm. Artery: 20-30/8-15mmHg
  4. PA Wedge: 8-12mmHg
50
Q

What can cause High PA Pressures?

A

LV Failure

Mitra Stenosis/Regurg

L-R Shunt

Atrial / Ventricular Septal Defect

Pulm. HTN

Catheter Whip/coil

51
Q

What can cause Low PA Pressures?

A

Hypovolemia

RV Failure

Tricuspid Regurg/Stenosis

52
Q

What can cause Low PA Wedge Pressures?

A

Hypovolemia

RV Failure

Tricuspid Regurg/Stenosis

Pulmonary Embolism

53
Q

What can cause High PA Wedge Pressures?

A

LV Failure

Mitral Stenosis/Regurg

Cardiac Tamponade

Constrictive Pericarditis

Volume Overload

Ischemia

Summer 2020 - Advanced Anesthesia - CV (9 decks)

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