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hemodynamics test review

Identifying marks for an arterial wave form? the vertical scale has higher numbers
Identifying marks for the CVP waveform? small thin line, lower to the horizontal scale line.
Identifying marks for the RV waveform? waveform hits the top and the bottom of the scale.
Identifying marks for the PAP waveform? peak is up tall but it never reaches the bottom.
Identifying marks for the PWP waveform? the line is thin and wiggly but higher on the scale than the CVP.
Normal value for Arterial? Sys 90-140 torr, Dia 60-90 torr, Mean 70-105
Normal value for CVP? 2-6 torr
Normal value for RAP? < 6 torr
Normal value for RV? sys 20-30 torr, dia 2-6 torr,
Normal value for PAP? sys 20-30 torr, dia 8-15 torr, mean 10-20 torr
Normal value for PWP? 4-12 torr
Normal value for CI? 2.5-4.5 L/min/m2
Normal value for QT? 4-8 L/m
Normal value for C(a-v)O2? 4-6 Vol%
Normal value for Stroke volume? 60-130ml/beat
Normal value for ejection fraction? 65-70%
Discuss preload? stretch of the ventricle before the contraction. Venous return is most important.
Discuss afterload? resistance that opposes ventricular ejection.
Procedure for placing an arterial line? assemble equipment, perform Allen's test, drape pt, inject 1% lidocaine, catheter inserted 30 degree angle, hold needle and advance catheter, remove needle and secure, attach drip and observe waveform.
Procedure for placing a pulmonary catheter? done by physician, check ballon for patency, inserted into selceted sight until reaches R atrium then inflate balloon with 1.5cc's.
Common sites for placing pulmonary catheter? subclavian or internal jugular
Common sites for placing arterial catheter? radial, brachial, or femoral.
Equipment needed for a pulmonary catheter? bedside cardiac monitor, pressurized saline bag, pressure amplifier/monitor, BTFD catheter, pressure transducer system.
Equipment needed for an arterial line placement? arterial catheter, flush device, hepranized saline bag, transducer, 4x4 sterile squares, lidocaine, betadine/alcohol, tape to secure.
What pressure is your hepranized bag placed at and what is the rate of your drip? pressurized to 300 torr and set to drip 2-4ml per hour.
Thermodilution method for measuring QT? dextrose or saline injected at room temp into the proximal port of pulmonary cath. measures heat loss in relation to blood flow. done several times to get and average.
Fick method for measuring QT? requires I and E gases as well as mixed, gold standard, but rarely used.
Pulse Contour C.O. monitoring? simultaneous measurements of art pressure and C.O. by other methods for a baseline. If art prssure goes up them C.O. will go up.
Estimated C.O. monitoring? central venous blood used. If C(a-v)O2 is up then C.I. will be down and vice versa. Keep sats above 95%.
Discuss SVR? Systemic Vascular Resistance- pressure on the vessel's throughout the body (from aorta).
Discuss PVR? Pulmonary Vascular Resistance- pressure on the pulmonary artery
Discuss vascular resistance? component of afterload determined by elasticity (compliance of vessel), size (radius), viscosity (how thick), changes in pressure (from one end of vessel to the other).
Discuss Ejection Fraction? fraction of end diastolic volume ejected with each beat. EF=SV/EDV. <30% exercise tolerance severly limited.
Discuss EDV? End Diastolic Volume- amount of blood before the contraction. Preload, or systole.
Discuss ESV? End Systolic Volume- amount of blood after the contraction. Afterload or diastole.
Discuss Cardiac Work? energy the heart uses to eject blood against the aortic or pulmonary pressures. Correlates with O2 requirments of heart. L ventricle has to work 6X harder then the R.
Calculate CaO2, CvO2, C(a-v)O2, C.O., and EF? CaO2- (Hbx1.34)(SaO2)+(PaO2x0.003), CvO2- (Hbx1.34)(SvO2)+(PvO2x0.003), C(a-v)O2- CaO2-CvO2, C.O.- HRxSV or VO2/C(a-v)O2 x 10, EF- SV/EDV.
Discuss factors that affect contractility of the heart? coronary blood flow, sympathetic nerve stimulation, Inotropic drugs, Physiologic depressants, damage to heart.
Discuss performance ability of the heart? HR and SV
Index measurements? measurements based on body size.
Left atrial filling pressures? preload and PWP
Right atrial filling pressures? amount of blood in R atrium or CVP
What do parameters do these reflect: CVP, PAP, PWP, C.O.? CVP- R heart, fluid management; PAP- lungs, mixed venous blood; PWP- L heart; C.O. blood pumped in one minute.
Discuss LCWI? amount of work on the left side of heart.
Discuss RCWI? amount of work on the right side of the heart.
Discuss LVSWI? directly related to SVR, mycardial mass, viscosity.
Discuss RVSWI? directly related to PVR, myocardial mass, viscosity.
Both LVSWI and RVSWI increase with? tachycardia, hypoxemia, and poor contractility.
Created by: ajwooly