Invasive Blood Pressure Monitoring
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| What are the indications for invasive blood pressure monitoring? | need for real-time continuous pressure monitoring, cuff measurement is unreliable, waveform diagnostics desired, repeated blood sampling needed
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| What are some potential complications of invasive blood pressure monitoring? | ischemia distal to site, hematoma-compartment syndrome, arterial trauma, infection, thrombus formation, vasospasm, bleeding, fistula, air embolus, heparin overdose (rare-only if flush bag contains heparin)
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| What is the most important determinant of LV after load? | blood pressure
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| Automated non-invasive blood pressure monitoring is based on __________ | oscillometry (measuring vibrations)
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| What are the components of an invasive blood pressure monitoring system? | catheter, tubing, stopcocks, extension tubing, transducers/diaphragms, flushing devices, amplifiers, cable connections, electronic filters
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| What does the transducer do? | it takes the mechanical signal and converts it into an electrical signal (what we see on our monitors)
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| What is dynamic response? | physical behavior of a system; it is characterized by elasticity, mass & friction; it is characterized & assessed by natural frequency and damping coefficient
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| What is hertz (Hz)? | a unit for measuring frequency; number of cycles per second; 1 cycles per second = 1 Hz
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| What is oscillation? | back and forth repeated motion
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| What is harmonics? | stretch and recoil of a spring; a series of oscillations in which each oscillation has a frequency that is an integral multiple of the same basic frequency; this is an abnormal occurrence.
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| What is resonance? | exaggerated wave amplitudes occurring when the monitored frequency matches the system's nature; frequency resulting in overshoot or overestimated wave reading (when harmonics occur the system is resonate)
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| What is natural frequency? | how easily or rapidly the system oscillates; all objects have a natural frequency at which they optimally vibrate when disturbed or struck
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| How is frequency measured? | in Hertz (Hz) {cycles per second}
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| The higher the natural frequency, the more ______ and _________ the signal quality with less distortion. | precise and accurate
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| Natural frequency should be at least ________ the frequency of the waveforms to be monitored. | 5 times
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| If the patient's heart rate to be monitored goes as high as 180, how many Hz are needed in the system? | 15 Hz (HR = 180, which is 3 Hz; 3 x 5 = 15 Hz)
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| What is the damping coefficient? | numerical indicator of the degree of damping
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| What is damping? | defines an object's tendency to cease vibrating/oscillating
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| Completely undamped system means a coefficient of what? What are the implications of this? | 0; object will likely continue to vibrate indefinitely
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| Completely damped system means a coefficient of what? What are the implications of this? | 1.0; object will instantly return to baseline resting state as soon as stimulus withdrawn
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| What is critical damping? What is the coefficient for this? | when one displacement causes one vibration; coefficient is 0.4
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| How does an under-damped system skew blood pressure readings? | SBP too high, DBP too low; MAP will be accurate; sharp and exaggerated waveform
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| How does an over-damped system skew blood pressure readings? | SBP too low, DBP too high; MAP will be accurate; wave form is smooth with no dicrotic notch
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| What does the dicrotic notch represent on an arterial waveform? | closing of the aortic valve
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| What is the lowest damping coefficient number that will provide accurate results? | 0.4
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| What is the ideal damping coefficient? | 0.6 - 0.7
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| What is the best method of calculating the dynamic response of an arterial blood pressure monitoring system? | square wave test
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| How do you perform the square wave test? | flush artline to make "square wave"; once done flushing observe number of oscillations before returning to baseline
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| How many oscillations are present before returning to baseline during the square wave test in an optimally damped system? | 1.5 - 2 oscillations before returning to baseline
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| How many oscillations on the square wave test represent an underdamped system? | > 2 oscillations before returning to baseline
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| How many oscillations on the square wave test represent an over damped system? | < 1 oscillation before returning to baseline
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| What is the optimal tubing length for an arterial blood pressure monitoring system? | 4 feet
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| Which system is easier to deal with...an underdamped system or an over damped system? | underdamped....because you can always add something to the system to dampen it more
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| Dynamic response issues affect ______ the most and _____ the least. Therefore, ______ is the most accurate reading, | SBP, MAP, MAP = most accurate reading
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| The properties of the system control __________, but the clinician can control the ___________. | natural frequency; damping
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| Decreased damping and natural frequency augments the wave and introduces _________ into the system. | resonance
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| Natural frequency should be as high as possible, greater than _____. | 7.5 Hz
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| Zeroing means you are taking the art line from ________ pressure to _________ pressure. | atmospheric; gauge
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| Where should the transducer be leveled? | 5 cm below sternal border at the 4th intercostal space corresponds with the aortic root
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| 1 cm of height is equal to.... | 0.75 mmHg
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| The level of the auditory meatus or tragus of the ear is equal to the _____________ and estimates _____. | Circle of Willis; CPP
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| Raising the patient about the level of the transducer will produce _______ pressure readings | higher
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| Lowering the patient below the level of the transducer will produce ________ pressure readings | lower
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| How does aortic stenosis change the arterial pressure waveform? | delayed upstroke, narrowed pulse pressure
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| How does aortic regurgitation change the arterial pressure waveform? | sharp rise, double peak
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| How does hypertrophic cardiomyopathy change the arterial pressure waveform? | spike and dome due to midsystolic obstruction
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| True or false: compliance of the vessel affects flow | true; older patients have less compliance
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Created by:
Mary Beth
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