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113 Cards in this Set

  • Front
  • Back
what is contractility
strength of vent contraction
force or energy of contraction
inotropic
what is chronotropic
rate of contraction
measurement of pressure, flow, volume, and oxygenation within the CV system
hemodynamics monitoring
volume of blood within ventricle at end of diastole
preload
what is preload AKA
stretching
things that decrease preload (4)
heart dys
hypovolemia
dehydration
systemic vasodilation (pooling)
what is left vent preload reflected by
PCWP
what is right vent preload reflected by
CVP
afterload AKA
resistance
forces opposing ventricular ejection
afterload
amount of blood ejected by the vents with contaction
stoke volume
what is cardiac output
hr x sv
determined by HR and rhythm, preload, afterload, contractility
cardiac output
what is cardiac index
CO adjusted for BSA
how to zero pressure lines
open stopcock to air
hit zero function on the mtr
and digital returns zero
when should the lines be zeroed
during initial set up of art line
STAT after insertion
what is 0
atmospheric pressure
where is the transducer placed to zero the line
phlebostatic axis
what does positioning the transducer allow for
measurement to be taken
what is phlebostatic axis
middle chest at 4th intercostal space
what pressure does a central line show
preload pressure
what are pressure bags set at for hemodynamics monitoring
300mmhg
how much does the flusher deliver.hr
3ml/hr
if the pressure shows green in window what does it mean
correct pressure
when are pressure bags used
art lines
reflects the amt of fluid returning to the r side of the heart (preload)
CVP
PA/swan themodilation cath can mtr what pressures (2)
pulomary artery pressure
PAWP
PA/swan can mtr what pressures
SVR
PVR
how can CVP be obtained
transducing central line
attach h20 filled column to line
proximal lumen of swan/pa line
cvp reflects what
r atrial filling (preload)
PAp reflects what
l atrial preload
PAWP reflects what
l atrial pressure -
PVR reflects what
resistance of the pulmonary bed
SVR reflects what
resistance of the vascular bed (afterload)
normal MAP
70-105mmhg
normal Co
4-8L/min
normal SVR
800-1200 dynes/sec/cm
normal PVR
<250 dynes/sec/cm
normal PAWP
6-12 mmhg
normal PA
15-25/ 8-15
normal CVP
2-8 mmhg
sites to mtr CVP
r jugular
subclavian
antecubital
what can affect the CVP measurements (2)
spontaneous breathing
positive pressure vent
what does spont breathing do to CVP
decreases
what does neg and pos pressure vent do to CVP
neg- decreases
pos-increases
blocking of arterial flow causes what
ischemia to tissues
reasons for art pressure mtr
HTN/hypo
resp failure/shock
use of vasopressors
freq ABGs
what should be done if blood gets in transducer
change the line
causes of art pattern dampening (4)
clot in line
blood backup in line
catheter tip against vessel wall
air/bubble in line
dicrotic notch
closin of the valve
difference in art line and cuff pressure
art is 5-10 mm hg higher
what should be done if bp cuff and art line pressures are diff (3)
make sure line is zeroed to air
insure proper cuff size
check for hypotension
what does elevation of the PA waveform mean
overinflation
distal tip of PA catheter sits where
pulmonary art pressure
if distal tip of cath is inflated what does it show
PAWP
indicators of cardiac function and fluid volume status (2)
PA DIASTOLIC PRESSURE
AND PAWP
how long can balloon be inflated
8-15 sec (4 resp cycles)
mls of inflation that are acceptable
1-1.5mls
if too much inflation occurs what could happen
tissue damage/pop it
proximal tip of cath
superior vena cava
red port of swans ganz
balloon
tells how fast and how much CO
swans ganz
decrease in PAWP mean....
fluid volume deficit
increase in PAWP means....
fluid overload
L vent failure
increase PA pressure and PAWP
L sided heart failure
increases PA and normal PAWP
pulmonary disease
decrease PA pressure
low volume
wedge pressure shows what
L vent function
characteristics of CVP (4)
right atrial
proximal port
reflects preload
blood sampling
right vent and reflects preload of L side
PAP
reflects L vent pressure
PAWP
afterload- resistance to blood flow in body
SVR
used to clamp off to IV fluids and pull of specimen to dilute then draw blood
VAMP
decreased PAWP means
FVD
increased PAWP
fluid overload
L vent failure
allows visualization on the waveforms during insertion of SWan
transducer
results in decreased SVR (3)
vasodilation
shock states
drugs that decrease afterload (nipride)
results in increased SVR (3)
vasoconstriction
hypovolemia
vasoactive agents
complications with PA/swan cath (5)
infection
sepsis
air embolus
vent ddysrhy
pulm infarction
done to prevent infection in cath every 96hrs
change flush bag
pressure tubing
transducer
stopcock
what should be done if PA cath cannot be wedged
repositioning
causes of pulm infarction or PA rupture (4)
balloon rupture
prolonged inflation
spont wedging
thrombus/embolus formation
how to prevent PA rupture/ pulm infarction (3)
never inflate beyond capacity
use 1-1.5 ml of air
check PA waveforms often
what should PA waveforms be checked often for (3)
occlusion
dislocation
spont wedging
what are the 3 components of the skull
brain tissue
blood
cerebrospinal fluid
what happens if the components of the skull change
pressure changes
causes changes in ICP (2)
occlusion
overproduction of CSF
changes in blood (7)
stroke
hematoma
trauma
BP
CO
increased flow
increased pressure
causes tissue changes (2)
edema
tumor
what happens if transducer is left open to atmosphere
free flow of blood
what must all stopcocks have
deadenders
luer locks
should always be monitored with hemodynamics
trends
CPP < 50 means...
no perfusion to cells
what is CPP
pressure needed to ensure blood flow to the brain
MAP-ICP
=CPP
normal CPP
70-100
what is CPP <50 associated with (2)
ischemia
neuronal death
high ICP =
no delivery of 02 and blood to cells
what happens if ICP increases
then pressure delivering blood increases also
where can ICP be measured (4)
ventricles (common)
subarachnoid space
epidural space
brain parenchymal tissue
normal ICp
0 -15mmhg
where should transducer be placed when monitoring ICp
tragus of ear bc its level with vents
how can ICP be controlled with catheter
by removing CSF
how should ICP be measured
as a mean pressure at the end of expiration
what is a serious concern when monitoring ICp
infection
what are the waveforms of ICP similar to
arterial pressure trace
what can cause inaccurate ICP readings (5)
CSF leaks
obstruction in cath
differences in ht of bolt/tranducer
kinks in tubing
incorrect height of drainage system
optimal level of CPP
60 or above
can help drive the MAP (2)
vasopressors
fluids
helps minimize ICp (3)
sedation
osmotic agents (3%NS)
ventriculostomy
what does 3%NS do
pulls fluid into blood stream to increase MAP and decrease ICp
dose for dopamine
<3mcg/kg/min