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Hemodynamic monitoring: Arterial Catheterixation (ART line)
-conditions requiring art line

-need for continuous blood pressure monitoring
- Need for frequent arterial blood sampling

-Shock states
-hypertensive crisis
-surgery in high risk pts
-use of potent vasoactive or inotropic drugs
-controlled hypotensive anesthesia
-situations that may lead to rapid changes in cardiac function.


Hemodynamic monitoring: Arterial Catheterixation (ART line):
-Absolute CI
-Relative CI
-what are the 6 common sites of ART lines? Which site is MC?

-none. :)

-bleeding problems (hemophilia)
-anticoagulant therapy
-presence of vascular prosthesis
-local infection

-radial artery (MC)
-axillary artery
-femoral artery
-dorsalis pedis artery
-superficial femoral artery
-brachial artery


What is one potential consequence of ART line placement in the brachial artery?

Complications of Arterial catheterization?

Risk of median nerve contracture (Volkmans contracture)

Complications of Arterial Catheterization:
-failure to cannulate
-disconnection from monitoring system
-infection (catheters placed more than 4 days, surgical insertion, local inflammation)
-retrograde cerebral embolization
-A-V fistula/ pseudoaneurysm
-sever pain, distal necrosis


Hemodynamic Monitoring: Central Venous Pressure:
-what does this measure?
-where is this usually placed?

What does it measure: measurement of the blood pressure in the right atrium and vena cava. This reflects the ability of the cardiac pump action to handle the returning blood volume at that particular time.

Where: thread a central venous catheter into any of several large veins -subclavian
-internal jugular
-external jugular
-basilic vein


Hemodynamic monitoring: Central Venous Pressure:
-CVP monitoring is a procedure to properly and promptly evaluate ____ and ____ in seriously ill patients.

CVP monitoring is a procedure to properaly and promptly evaluate OPTIMAL FLUID and BLOOD REQUIREMENT in seriously ill patients.
**removes much of the guess work in rapid restoration and maintenance of adequate circulation w/o fear of overloading the heart,


Hemodynamic monitoring: Central Venous Pressure Monitoring:

-MC complication of CVP placement in the subclavian vein?

Subclavian vein complication is pneumothorax

-when massive blood replacement is instituted rapidly in rapid exsanguinating type of bleeding
-acute blood volume deficit in cases operated for strangulating type of intestinal obstruction where rapid fluid replacement is indicated.
-obscure cases of shock immediately post-op whether hypovolemic d/t internal bleeding or nonhypovolemic in MI
-In surgical patients with anuria d/t possible renal shutdown
-elderly patients with limited cardiac reserve undergoing difficult time consuming operations.


Central Venous Pressure:
-what is normal?

Normal: 4-7cm

Low: 0-3 (indicates blood volume is below normal blood volume the heart can handle)

High: 8-20 (more than the heart can handle)


Central Venous Catheterization:

-access for fluid therapy
-access for drug infusion
-parenteral nutrition
-CVP monitoring
-aspirate air embolism
-placement of cardiac pacemaker / vena cava filters
-hemodialysis access

-useful in hypotensive pts
-tracing for arrhythmias
-gives info about relationship between intravascular volume and right ventricular function
-use of water manometer for pressure measurements


Pulmonary Artery Catheterization (PAC):
-what is one type called?
-what is this?
-measures pressure where?

Called: Swan-Ganze Pulmonary artery catheter

What: insertion of catheter into the pulmonary artery.

-detect heart failure, sepsis, monitor therapy, and evaluate the effects of drugs.

Allows direct, simultaneous measurement of pressures in:
-the right atrium
-right ventricle
-pulmonary artery
-filling pressure (wedge pressure) of left atrium.


Pulmonary Artery Catheterization:

-management of complicated MI
-Assessment of respiratory distress
-Assessment of type of schock
-Assessment of therapy (afterload reduction, vasopressors, beta blockers)
-assessment of fluid requirement in critically ill pts
-management of postop open heart surgical pts
-assessment of valvular dz
-assessment of cardiac tamponade/constriction


Pulmonary Artery Catheterization:
-inserted into which veins?

Inserted into a major vein suchs as:
-jugular, subclavian, or femoral
**First choice is RIGHT INTERNAL JUGULAR VEIN, it is the shortest and straightest path to the heart.


Respiratory Monitoring:
-monitors what?

Monitors ventilation and gas exchange

-decision making for the need of mechanical ventilation
-assessment of response to therapy
-optimize ventilatory management
-decision to wean from ventilator


Respiratory monitoring;
Ventilation Monitoring:
-Define each of the following:
--tidal volume
--Vital capacity
--minute volume
--physiologic dead space

Tidal volume = volume of air moved in or out of the lung in a single breath

Vital capacity: maximal volume at expiration after a maximal inspiration

Minute volume: total volume of air leaving the lung each minute

Dead space: portion of tidal volume that does not participate in gas exchange. May be anatomic or phsyiologic dead space.


Respiratory Monitoring:
-Gas monitoring:
--measuring what?
--which tests are used?

Measuring PO2 and PCO2

-pulse oximiters
-blood gas analysis
--efficacy of gas exchange
--adequacy of alveolar ventilation
--acid base status
-gastric tonometry (monitors aerobic metabolism in organs whos superficial mucosal lining is extremely vulnerable to low flow changes and hypoxemia)


Renal Monitoring
-T/F, the kidney is an excellent monitor of adequacy of perfusion?
-what is normal urine output?
-Glomerular function tests?


Normal urine output: 0.5ml/kg/hr

GFR tests:
-plasma creatinine
-creatinine clearance* (most reliable way of assessing GFR) (used if plasma creatinine values affected by muscle dz)
-Tubular Function tests (most reliable test to distinguish pre-renal azotemia from tubular necrosis)


Neurologic monitoring:
-what tests?
--what value should the test be?

-Intracranial pressure
Cerebral perfusion pressure greater than 70mmhg

-Glasgow Coma Scale

-electrophysiologic monitoring (reflects spontaneous and on-going electrical activity of brain)

-Transcranial US (monitors cerebral blood flow and detects vasospasm)

-Jugular venous oximetry (measure relationship of blood flow to O2 consumption)


What is considered when monitoring metabolism?

Temperature Monitoring:

Caloric demands and respiratory quotient of food.

-middle ear