Week 12 Handout-Flipped 3-part 1

Question 1

What is the primary purpose of arterial line monitoring?

Answer 1

Continuous direct monitoring of arterial blood pressure

Provides real-time visualization of beat-to-beat pressure variations

Question 2

What are the immediate benefits of arterial line monitoring?

Answer 2

Immediate detection of blood pressure fluctuations, allowing for precise titration and administration of vasoactive medications

Question 3

What is considered the gold standard for accurate end-organ perfusion?

Answer 3

Arterial line monitoring

Question 4

List useful patient populations for arterial line monitoring.

Answer 4

• Patients undergoing high-risk surgeries
• Cardiac surgeries
• Aortic aneurysm repairs
• Trauma surgeries
• Craniotomies
• Carotid endarterectomy

Question 5

What are some comorbidities that may necessitate arterial line monitoring?

Answer 5

• Coronary artery disease
• Valvular disease
• Heart failure
• History of cerebrovascular disease

Question 6

True or False: Arterial line monitoring is only indicated for high-risk surgeries.

Answer 6

False

It can also be indicated for patients with severe comorbidities and metabolic derangements

Question 7

What is the preferred site for arterial line insertion?

Answer 7

Radial artery

Question 8

Why is the radial artery preferred for insertion?

Answer 8

Due to superficial location and substantial collateral flow

Question 9

What is Allen’s Test used for?

Answer 9

To confirm patency of ulnar artery circulation prior to radial artery cannulation

Question 10

List the steps of Allen’s Test.

Answer 10

• Compress both ulnar and radial arteries while patient tightens fist
• Release pressure on ulnar artery
• Confirm collateral flow by flushing of the thumb within 5 seconds

Question 11

What is the consequence of a loss of collateral circulation in arterial line placement?

Answer 11

Increased risk of ischemia in the hand

Question 12

What should be done to zero the transducer in arterial line monitoring?

Answer 12

Open a stopcock to air at the phlebostatic axis

Question 13

Where should the transducer be zeroed in a seated neurosurgery patient?

Answer 13

At the Circle of Willis

Question 14

What does a rapid upstroke in the arterial waveform indicate?

Answer 14

Strong left ventricular contractility

Question 15

What causes an under-dampened arterial waveform?

Answer 15

Poor vascular compliance, stiff tubing, catheter whip

Question 16

What happens to SBP and DBP in an over-dampened arterial waveform?

Answer 16

SBP is underestimated, DBP is overestimated

Question 17

What does the square-wave test help determine?

Answer 17

Natural damping characteristics of the transducing system

Question 18

What is pulse pressure variation used to assess?

Answer 18

Fluid responsiveness

Question 19

What are contraindications for arterial line placement?

Answer 19

• Severe coagulopathy
• Severe peripheral vascular disease
• Raynaud’s or Buerger’s disease

Question 20

List common complications of arterial line placement.

Answer 20

• Infection
• Thrombus formation
• Air embolus
• Skin necrosis
• Pseudoaneurysm
• Nerve damage

Question 21

What indicates fluid responsiveness in pulse pressure variation?

Answer 21

Variations greater than 12-13%

Question 22

What is the most common site for arterial line insertion?

Answer 22

Radial artery

Question 23

Fill in the blank: The _______ should be zeroed at the phlebostatic axis.

Answer 23

transducer

Question 24

What part of the arterial line waveform corresponds to aortic valve closure?

Answer 24

Dicrotic notch

Question 25

What does Central Venous Pressure (CVP) measure?

Answer 25

Direct measure of the pressure within the venous system near the Right Atrium (RA) ## Footnote CVP provides insight into intravascular volume, cardiac function, and fluid status.

Question 26

What is required to accurately measure CVP?

Answer 26

A Central Venous Catheter (CVC) ## Footnote The tip of the CVC should be just outside the junction of the RA and the Venae Cavae.

Question 27

List the three main factors that affect CVP.

Answer 27

* Intravascular Volume * Backup/Backflow of blood * Intrathoracic Pressure

Question 28

Where can a Central Venous Catheter (CVC) be placed?

Answer 28

* Internal Jugular Vein * Subclavian Vein * Femoral Vein * Basilic Veins * External Jugular Vein

Question 29

What is the Seldinger technique?

Answer 29

A method for CVC placement using a guidewire ## Footnote It involves placing a needle, threading a guidewire, and then placing the catheter over the guidewire.

Question 30

What are the benefits of Central Venous Catheter (CVC) placement?

Answer 30

* Direct and accurate measure of RA pressure * Assessment of fluid status * Fast fluid administration * Administering caustic drugs or TPN * Venous access for poor peripheral veins

Question 31

List the risks associated with CVC placement.

Answer 31

* Pneumothorax * Hemothorax * Infection (CLABSI) * Air or thrombus embolism * Hematoma * Arrhythmias * Cardiac perforation / Tamponade

Question 32

What are contraindications to CVC placement?

Answer 32

* Tumors * Infection at the site of insertion * Thrombus * Tricuspid Valve vegetation

Question 33

What causes the A wave in the CVP waveform?

Answer 33

Contraction of the RA ## Footnote It occurs immediately after the P wave.

Question 34

What does a large V wave in the CVP waveform indicate?

Answer 34

Tricuspid Regurgitation or an acute increase in volume ## Footnote Large V waves can cause CVP to be inaccurate.

Question 35

What does a low CVP indicate?

Answer 35

Low intravascular volume (hypovolemia) ## Footnote CVP typically ranges from 1-10 mmHg.

Question 36

What conditions can result in a high CVP?

Answer 36

* Fluid overload * RV Failure * Pulmonary HTN * Tricuspid Valve regurgitation or stenosis * Cardiac Tamponade * Increased intrathoracic pressure

Question 37

What is the Frank-Starling mechanism?

Answer 37

A principle that describes the relationship between stroke volume and end diastolic volume ## Footnote It is important for understanding fluid management in patients.

Question 38

Which patients could benefit from CVP monitoring?

Answer 38

* Cardiac Surgery patients * Those with hemodynamic instability * Shock * Heart Failure

Question 39

What are common abnormalities in the CVP waveform?

Answer 39

* Cannon A waves * No A waves * Large V waves

Question 40

True or False: The Seldinger technique is the least common method for CVC placement.

Answer 40

False ## Footnote The Seldinger Technique is by far the most common CVC placement technique.