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Sim Lab > Session 26: Arterial Line > Flashcards

Session 26: Arterial Line Flashcards

1
Q

arterial line indications

A

repetitive blood sampling
real time BP monitoring
inability to measure w/NIBP

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2
Q

arterial blood gases

A

most accurate PO2 values

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3
Q

most venous draws are within _____% of ABG

A

95%

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4
Q

types of repetitive blood sampling

A

Hb
Na+
Ca2+
PTH

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5
Q

reasons for real-time BP monitoring

A

sympathomimetic infusions
strict BP control
- aneurysm
- vessel surgery
resuscitative end points

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6
Q

what can resuscitative end points help determine

A

volume status

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7
Q

what could make it difficult to measure NIBP

A

fistula
burns
morbid obesity
LVAD

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8
Q

arterial lines absolute CI

A

inadequate circulation
- cold limb
raynaud’s
buerger’d
full-thickness burns

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9
Q

arterial lines relative CI

A

previous sx
- distorted anatomy
anticoag/coagulopathy
- DIC
active skin infection
atherosclerosis
inadequate collateral flow
partial-thickness burn

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10
Q

arterial lines complications

A

hematoma
infection
bleeding
ischemia
thrombosis/embolism
AV fistula formation
pseudoaneurysm formation

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11
Q

arterial spasm

A

radial > femoral

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12
Q

arterial occlusion

A

radial > femoral

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13
Q

ischemia

A

femoral > radial

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14
Q

internal bleeding

A

femoral > radial

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15
Q

infection

A

femoral > radial

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16
Q

radial artery location

A

thumb side of wrist
superficial

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17
Q

collateral flow for radial artery

A

ulnary artery

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18
Q

allen’s test: positive

A

hand does not flush within 7 seconds

positive result is bad

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19
Q

2nd most common art line site

A

femoral artery

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20
Q

femoral artery catheter

A

longer and larger
requires seldinger wire

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21
Q

femoral hematoma

A

compress against femoral head to relieve

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22
Q

brachial artery

A

lack of collateral flow

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23
Q

brachial artery location

A

medial aspect of bicep head in antecubital fossa

24
Q

dorsalis pedis art line

A

used in peds

25
Q

art line equipment

A

chloraprep
4x4 gauze
catheter
arm board/wrist roll
pressure bag w/flushed transducer and cable
tegaderm
continued antiseptic
tape

26
Q

art line needle length

A

1.75”

27
Q

radial catheter size

A

20g

28
Q

femoral catheter size

A

18g
16g (10cm)

29
Q

brachial catheter size

A

20g (10cm)

30
Q

arrow catheter size

A

20g

31
Q

art line kit: femoral/brachial

A

35 cm J tip seldinger
3” fenestrated drape
3mL syringe
18g injection needle
20g introducer needle
25g injection needle
gauze
1% lido
1.75” 20g catheter
#11 scalpel
5” 20g catheter
3-0 suture w/straight needle
iodine prep

32
Q

pressure tubing capacitance

A

low capacitance
- stiff
- limits stretching
- higher freq

33
Q

factors that increase artifact

A

incr length
stopcocks
in-line syringes

34
Q

how do you keep art line patent?

A

flushing

35
Q

intermittent art line flush

A

every 15-30 mins

36
Q

continuous art line flush

A

2-3 mL/hr

(built in to new systems)

37
Q

fluid compressibility

A

minimally compressible

38
Q

overdampened

A

narrow PP
falsely low BP

39
Q

overdampening causes

A

air bubbles
kinking
clot

40
Q

underdampened

A

wider PP
falsely high BP

41
Q

underdampened causes

A

tachycardia
hypothermia

42
Q

MAP in under and overdampened systems

A

minimally unchanged

43
Q

potential art line resonance issues

A

flexed wrist
kinked catheter
loose connections
closed stopcocks
needs to be zeroed
needs to be flushed

44
Q

peak of art line waveform

A

ESV

45
Q

underdampened post-flush

A

> 2 oscillations

46
Q

underdampened BP

A

overestimates systolic
underestimates diastolic

47
Q

optimal post-flush

A

1-2 oscillations

48
Q

overdampened post-flush

A

no oscillations
no dicrotic notch

49
Q

overdampened

A

underestimates systolic
overestimates diastolic

50
Q

pulsus paradoxus

A

systolic pressure drop of 10mmHg during inspiration

decr end-diastolic preload
decr SV

51
Q

pulsus alternans

A

frank-starling mechanics
- changes ESV
papillary muscle contractility decreased
- ischemic event

52
Q

pulsus bisferiens

A

2 systolic peaks
- regurgitant aortic valve
- back fill into relaxing ventricle
- venturi effect/arterial muscular collapse

aortic insufficeincy
aortic stenosis

53
Q

pulsus parvus et tardus

A

slow systolic rise
due to aortic stenosis

54
Q

the radial artery is tethered to

A

the tensor retinaculum

55
Q

what angle do you insert the arterial line

A

45 degrees until flash

56
Q

arterial line verification

A

monitor
ability to withdraw blood
sustained brisk blood return

57
Q

zero transducer

A

off to pt
open to air
“zero” on monitor
turn off to air

Sim Lab (23 decks)

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