ANP1 Exam 3
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
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CVP meaasures | ~RAP ~Right end-diastolic volume
~best indicator of right atrial pre-load
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CVP indications | 1. fluid mgmt hypovolemia & shock
2. assess venous return & volume status
3. surgery w/ large fluid shifts/blood loss
4. caustic or TPN infusions
5. aspiration of air emboli
6. transvenous pacing
7. need venous access
8. sepsis, HF, Resp. Fa
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CVP contraindications | 1. renal cell tumor extension to RA
2. fungating TV vegetation
3. IJ CI w/ anticoagulants & ipsilateral carotid endart (poss carotid puncture)
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CVP location | catheter tip just above SVC/RA junction
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CVP SC | 1. high risk of pneumo during insertion
2. line-related infection with long duration
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CVP IJ | 1. RIJ comb accessibility & safety
2. LIJ increased risk: vascular erosion, pleural effusion, chylothorax (thoracic duct wraps around IJ on left)
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normal CVP range | 2-6
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when to read CVP | ~end-expiration
~after 'a' wave
~before 'c' wave
~reflect pre-systolic RV pressure
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CVP risks | 1. infection
2. air / thrombus embolism
3. dysrhythmias
4. hematoma
5. pneumo
6. hemothorax
7. hydro/chylothorax
8. cardiac perf
9. tamponade
10. artery/nerve trauma
11. thrombosis
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CVP waveform | ~corresponds to cardiac cycle
~ 3 peaks
~2 descents
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CVP 'a' wave | ~from atrial contraction
~absent in afib
~exaggerated in juctional
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CVP 'c' wave | TV elevation during early ventric contraction
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CVP 'v' wave | venous return against closed TV
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CVP 'x' / 'y' descents | caused by downward displacement of ventrical during systole and TV opening during diastole
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CVP falsely elevated fluid volume | ~if RV fails to empty d/t PHTN or LVF
~high CVP incorrectly suggests fluid overload
~need PA
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