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Sp: Sim Lab 1 > 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
art line equipment
chloraprep 4x4 gauze catheter arm board/wrist roll pressure bag w/flushed transducer and cable tegaderm continued antiseptic tape
26
art line needle length
1.75"
27
radial catheter size
20g
28
femoral catheter size
18g 16g (10cm)
29
brachial catheter size
20g (10cm)
30
arrow catheter size
20g
31
art line kit: femoral/brachial
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
pressure tubing capacitance
low capacitance - stiff - limits stretching - higher freq
33
factors that increase artifact
incr length stopcocks in-line syringes
34
how do you keep art line patent?
flushing
35
intermittent art line flush
every 15-30 mins
36
continuous art line flush
2-3 mL/hr (built in to new systems)
37
fluid compressibility
minimally compressible
38
overdampened
narrow PP falsely low BP
39
overdampening causes
air bubbles kinking clot
40
underdampened
wider PP falsely high BP
41
underdampened causes
tachycardia hypothermia
42
MAP in under and overdampened systems
minimally unchanged
43
potential art line resonance issues
flexed wrist kinked catheter loose connections closed stopcocks needs to be zeroed needs to be flushed
44
peak of art line waveform
ESV
45
underdampened post-flush
>2 oscillations
46
underdampened BP
overestimates systolic underestimates diastolic
47
optimal post-flush
1-2 oscillations
48
overdampened post-flush
no oscillations no dicrotic notch
49
overdampened
underestimates systolic overestimates diastolic
50
pulsus paradoxus
systolic pressure drop of 10mmHg during inspiration decr end-diastolic preload decr SV
51
pulsus alternans
frank-starling mechanics - changes ESV papillary muscle contractility decreased - ischemic event
52
pulsus bisferiens
2 systolic peaks - regurgitant aortic valve - back fill into relaxing ventricle - venturi effect/arterial muscular collapse aortic insufficeincy aortic stenosis
53
pulsus parvus et tardus
slow systolic rise due to aortic stenosis
54
the radial artery is tethered to
the tensor retinaculum
55
what angle do you insert the arterial line
45 degrees until flash
56
arterial line verification
monitor ability to withdraw blood sustained brisk blood return
57
zero transducer
off to pt open to air "zero" on monitor turn off to air

Sp: Sim Lab 1 (23 decks)

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