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Life Support #2

Monitoring Systems (A-line)

Components of a Fluid Filled monitoring system intravascular catheter, low compliance tubing, transducer, amplifier/monitor, continuous flush system
The intravascular catheter is semi- ___ and provides access to ___ ____, _____ rigid;central veins, arteries
The low compliance/____ tubing connects what to what? rigid; intravascular catheter to transducer
Max length of the low compliance tubing should be no greater than 3-4 ft
This receives low voltage electrical signal from the transducer and increases the signal amplitude to be displayed on the monitor Amplifier/monitor
The amplifier/monitor responds rapidly to changes, creating real time display correlating with ___ ECG
The flush system continuously flushes fluid through the system at a rate of __ml/hr 3
Each beat of the heart generates a __ ___ __ (arterial pulse) complex pressure wave
The arterial pressure is propagated through systemic circulation at a given ____ frequency (bpm)(
The resulting sine wave is called the first ___ harmonic
Phase I of the arterial pressure waveform = early systole, inotropic component
The steepness, rate and height of the anacrotic rise in Phase I are related to stroke volume and LV contraction
What is Phase II of the arterial pressure waveform? Systole, Volume displacement curve, Continued ejection of SV from ventricle
What is Phase III of the arterial pressure waveform? Late systole and Diastole, Sloping decline, dicrotic notch
This Phase of the arterial pressure waveform has the anacrotic notch and volume displacement curve Phase II
This Phase of the arterial pressure waveform consists of the anacrotic rise (inotropic component) Phase I
What is Damping? Friction that slows down and reduces the amplitude of oscillations
What are the 3 damping factors? Elasticity(compliance of pressure tubing), Mass of fluid in tubing and cath, and Friction(viscosity and flow of the fluid/blood)
Underdamped waveform appears narrow, peaked
Effects of underdamped waveforms on BP measurements Overestimates/Inaccurately high SBP; Underestimates/inaccurately low DBP
What can cause an underdamped waveform? long tubing
Overdamped waveform appears how Widened and slurred, dicrotic notch not clearly visible
Overdamped effects on BP measurements underestimates/inaccurately low SBP, Overestimates/inaccurately high DBP
Causes of overdamped waveform air bubbles, overly compliant tubing, kinks, clots, stopcocks
The ability of a fluid filled monitoring system to accuraely reproduce the true pressure pulse on the monitor is called Dynamic response
What is the name of the test for dynamic response? Square wave/fast flush/snap test
If the fast flush test generates numerous oscillations that extend below baseline, what kind of system does that indicate? underdamped
If the fast flush test generates no oscillations below the baseline (no "ringing" after flush), what kind of system does that indicate? overdamped
Use ___, not SBP or DBP for monitoring bc ___ is less subject to error MAP
2 reasons for having an A-Line frequent blood draws and BP monitoring
4 ways to insure accuracy of fluid filled monitoring system unobstructed, zeroed, leveled, and calibrated properly
What is the number 1 cause there is no waveform? stopcock turned off to patient
Troubleshooting: no waveform, what do you do? check for kink, clot(aspirate first, do not flush), Check stopcock not off to pt, check pressure bag setting, check for loose connections, verify zero and level
What causes artifact? catheter whip
If you see Artifact what should you do? check pt movement, perform dynamic response testing to determine underdamping
Steps to assemble A-line collect equipment, puncture flush bag, attach pressure bag, tighten connections, prime press. tubing with flush soln changing stopcocks as you progress, inflate bag to 300mmHg, inspect for kinks/bubbles, connect to monitor, level and zero, connect to pt.
Blood pressure is _____ at all points in the arterial system, _____ affects BP not equal; gravity
ABP ____ downward from the heart level and _____ upwards from the heart level increases; decreases
Why should all BP measurements be taken at the heart level? to eliminate the affect of gravity on hydrostatic pressure
Leveling eliminates this type of pressure hydrostatic
This is an accurate reference to establish a standard neutral level for all measured pressures zeroing
Zeroing eliminates this type of pressure atmospheric
Where is the phlebostatic axis? midaxillary line, level of RA, 4 ICS, 1/2 AP diameter
Intravascular volume(Preload), Pump efficiency, SVR, and PVR(afterload) are all effected by what during Systole? Stroke volume
What is stroke volume? the volume of blood ejected from the heart with each beat
These factors influence ABP during Diastole Vascular resistance(SVR, PVR), vascular tone, heart rate
How does heart rate affect diastolic pressure? it changes the duration of diastole and the pressure continues to fall until next systole
SVR equation and Norm SVR=[(MAP-CVP/CO) x80] Norm: 770-1500 dynes/sec/cm-5
PVR equation and Norm PVR=[(MPAP-PWP/CO) x80] Norm: 20-120 dynes/sec/cm-5
What causes ABP to decrease? Hypovolemia, vasodilation(shock, vagal stimulation), cardiac failure
What causes ABP to increase? Vasoconstriction(sympathetic stimulation, vasopressors), improvement in circulating volume, Increase in Stroke Volume
What is compensatory vasoconstriction? vasoconstriction maintains ABP within acceptable range even though significant decreases in intravascular volume or SV may be present
What may still exist with compensatory vasoconstriciton? organ hypoperfusion
This is an early sign of changes in circulating blood volume? Changes in Pulse pressure
Pulse pressure is directly related to what? acute changes in SV; SV increases=PP increases, SV decreases=PP decreases
Normal PP range 25-80mmHg
Mean PP 40mmHg
low pulse pressures can indicate what 2 things? CHF and shock
What can cause high pulse pressures Stiff arteries, aortic regurgitation
What is the average driving force in the arterial system throughout the cardiac cycle known as? Mean arterial pressure
MAP is used to calculate what? SVR and PVR
Normal MAP is 70-105
MAP below 60 indicates circulation to vital organs may be compromised and poor tissue perfusion
Why does SBP become progressively higher toward the peripheral arteries? bc they are narrower
MAP is less affected by what 2 things ? motion artifact and damping factors
When is MAP not reliable? HR > 120
Systolic measurements by cuff may be __mmHg lower than arterial SBP 20mmHg
Diastolic measurements by cuff may be generally __ than arterial DBP higher
indications for Arterial cannulation hemodynamically unstable pt, pt on vasoactive drips (EPI, dopamine), pt with IAB, Perioperative pt
Contraindications of arterial cannulation hemorrhagic disorders, anticoagulant therapy, thrombolytic agents, Site specific: dialysis shunt, infection, grafts, vascular surgery, negative allens test
This insertion site is the largest vessel, useful in cardiopulmonary arrest femoral
Order of arterial insertion sites radial, brachial, pedal or femoral, axillary
Hazards of arterial cannulation hemorrhage, thrombus, air embloli, systemic infection, site infection, arterial spasm, vascular occlusion
Created by: Dabi2