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Swan-Ganz Catheters
Nursing
Question | Answer |
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Hemodynamic monitoring is | the measurement of pressure, flow and O2 of the blood within the cardiovascular system |
Hemodynamic Monitoring is a diagnositc tool used for | continuous monitoring of force and flow of blood |
hemodynamic monitoring is allows for | monitoring response o therapies in terms of pressure, flow and O2 within the blood |
Nurse's role within hemodynamic monitoring | you must know the current treatments and how they work, focus on patient safety outcomes and be prepared to take action based on data |
What are the hemodynmic monitoring system five basic components | bedside manner, flush system, transducer, high pressure tubing, and catheter |
The hemodynmic monitoring system's catheter measures from | pulmonary artery, central venous, and arterial |
Procedure for setting up the hemodynmic monitoring system | Place 500cc bag of NS spiked c pressure tubing under the pressure bag & inflate to 300mmhg, prime tubing, level the lines with the patient, zero the lines, test the system and set alarms. |
To ensure accuracy, why do you level hemodynmic monitoring system | eliminate effects of hydrostatic pressure on transducer |
where do you level hemodynmic monitoring system | with phlebostatic axis (4th intercostal space, midaxillary line |
How to you zero? | turn stopcock and open to air |
how do you caliberate | using the biomed function of bedside monitors |
Dynamic response /square T wave is tested tosee if | the system is accurately transmitting the pressure detected in the vessel. |
How to you do the dynamic response/square t wave test? | pull the pig tail and release for a fast flush, should produce a square wave. Normal is 1-2 oscillations below the baseline |
when is the dynamic response... done? | after blood draws, or is accuracy is questioned, Q8-12 hrs |
What is necessary to maintain patency and avoid clots? | constant flow of sterile solution |
why must connections be secured | to withstand pressure |
transducer position directly affects | accuracy |
When do you repeat leveling? | every position, pole or bed change |
When is zeroing done? | every shift |
Stroke volume is | the amount of blood leaving the LEFT VENTRICLE with each CONTRACTION |
What is a normal stroke volume? | 60-100ml /beat |
stroke volume is sensitive to | changes in preload, afterload and contractility |
Cardiac Output is | the amount of blood leaving the LEFT VENTRICLE per MINUTE |
CO= | HR x SV |
Normal CO is | 4-8 L/minute |
Where is the CO obtained? | pulmonary artery catheter |
Cardiac Index | CO per square meter of the body; more accurate than CO |
CI | =CO/BSA |
BSA is determined by | (weight in Kg x .425)(height in cm(.725) x .007184 |
Normal CI is | 2.2-4.0L / min |
if CI is low | it is not enough to perfuse to all organs = cellular death |
Contractility are made of | positive inotropes and negative inotropes |
Positive inotropes | catecholamines, sympathetic stimulation, drugs (digoxin, dopamine, dobutamine, epinephrine and norepinephrine) |
negative inotropes | acidosis, barbituates, alcohol, hypoxemia, drugs (progainamide, calcium channel blockers, and beta blockers) |
Ejection fraction is | the percentage of blood that is efected with each heart beat |
normal ejection fraction is | 65% (thus 35% is a reserve) |
less than 35% ejection fraction is | serious ventricular failure |
Contractility is | the force generated by the myocardium, related to the ability of the ventricle muscle fibers to lengthen/stretch |
Frank-sterling law: | cardiac muscle fibers will strtch to accommodate the venous return of diastole |
what is the optimal filling pressure in contractility | 10-12 mmhg |
if greater than 12 than | cardiac muscle fibers are overstretched and the force produced decreased leading to HF |
Preload- R Atrial (CVP) reflects the | pressure of the vena cava and RA, volume as well, but it is actually EDP |
RV preload is dependent on | RA blood colume, CO and venous vascular resistance |
CVP/RAP | 2-8 mmHg |
Low CVP is | hypovolemia |
CVP is determined by | CVP line of pulmonary artery catheter |
Preload LVEDP (left Ventricular end diastolic pressure) | is the volume of blood in a chamber at the end of diastole, and how we measure L V preload |
Pulmonary Artery occlsive pressure is | an indirect measure of the pulmonary capillary pressure and reflects the LVEDP under normal conditions |
Normal PAOP = | 6-12 mmHG |
Pulmonary Artery can be used as an estimate if | balloon is not working |
you must have what to obtain LVEDP measurement? | PAC |
Reasons for High PAOP | LV failure, myocardial failure, constrictive pericarditis, cardiac temponade, MV disease, fluid volume overload |
Reasons for Low PAOP | fluid volume deficit, shock states, vasodilating medications |
Afterload | the pressure the ventricles must overcome to eject blood |
vascular resistance is | the major determinant but also affected by resistance offered by aortic valave, mass and density of blood |
SVR= | (MAP-CVP) x 80/ CO |
Pulmonary system afterload = | PVR systemic ciculation = SVR |
Normal PVR | < 250 dynes/s/cm-5 |
SVR | =800-1200 dynes s/cm-5 |
elevated SVR maybe due to | hyperthermia, vasodilation, or drug therapy |
invasive Pressure monitoring | intra-arterial catheters, central venous catheters, pulmonary artery catheters |
intra arterial catheters | never for infusions, must fo an Allen's test first or a stick, radial artery is most common site, monitor continuous BP, used for those with unstable BP; those needing frequent blood draws/gasses; vasoactive meds requiring titration; careful monitoring |
Arterial Waveforms | sys/and dystolic pressure by the heart' mechanical activity, dicrotic notch is aortic valve cloorue end of systole and begining of dystole |
factors influencing ABP waveforms | cardiac arrhythmias , distance between heart and catheter site |
MAP | ((2*DBP)+SBP)/3 |