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44 Cards in this Set
- Front
- Back
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Arterial catheters - reasons |
beat to beat b/p monitoring and blood draws |
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Vessels used for cannulation |
radial, brachial, axillary, femoral, dorsalis pedis, umbilical (newborns) |
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Arterial catheters information |
SBP, DBP, MAP MAP = (2DBP + SBP) / 3 correlates with QRS Waveform depends on artery used more distal higher PP - SBP Higher and Lower DBP arrhythmias - non perfusing dampened trace - air transducer, clot in catheter |
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Aline tracing |
A= upstroke = anacrotic limb B = systolic pressure C= dicrotic notch (aortic valve closure) D= diastole area under curve = stroke volume |
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Arterial pressure contraindications |
vasculitis (raynauds) infection ischemia |
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complications with arterial line
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infection, hematoma, nerve damage, vasospasm, hemorrhage, thrombosis, necrosis, and loss of digits |
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Central venous pressure |
approximation of right atrial pressure major determinant of right ventricular end diastolic volume (preload) estimate intravascular volume assess venous tone assess RV function |
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CVP reflection of |
Cardiac function and venous return to the heart |
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CVP waveform |
3 peaks and 2 descents |
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A wave |
occurs after the P wave RA contraction end diastole represents the atrial kick - tricuspid valve open CVP closest to RVEDP |
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Z point |
occurs just before TV closure coincides with middle to end of QRS approximates RVEDP for patients in Afib |
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C wave |
RV isovolumetic contraction tricuspid valve bulges into the RA follows the QRS |
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X descent |
atrial relaxation occurs during RV ejection pressure decreases as the tricuspid valve is pulled away from the RA systolic decrease in atrial pressure |
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V wave |
venous filling of the RA through the vena cavae occurs during late diastole tricuspid valve is closed peaks just after t wave |
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Y wave |
occurs in early diastole tricuspid valve opens passive filling of the RV |
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Decreased CVP |
hypovolemia spontaneous respiration transducer too high |
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Increased CVP |
fluid overload RV or LV failure pulmonary HTN RV diastolic dysfunction tricuspid or pulmonic valve disease mechanical ventilation - increased intrathoracic pressure |
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CVP aid to diagnosis |
Short PR = fusion of a and c waves Tachycardia - fusion of y and a waves Afib - no A WAVE and large C wave atrial volume |
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Elevated A wave |
resistance to RV filling tricuspid stenosis decreased RV compliance pulmonic stenosis pulmonary HTN Cannon A wave = junctional rhythms or contraction against closed TV |
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Tricuspid valve disease |
TR - abnormal systolic filling of atrium, Tall CV wave, no x descent TS - decreased passive filling during early diastole, prominent a wave, decreased y descent, elevated CVP |
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Elevated a and v waves |
cardiac tamponade constrictive pericarditis hypovolemia RV failure |
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Central line indications |
monitoring CVP pressure vasoactive meds or irritating meds, hyperalimenation massive volume difficult peripheral access aspiration of emboli intracardiac pacing, hemo, long term med, frequent blood sampling |
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Absolute contraindications for Central Line |
SVC syndrome or infection rate |
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Relative contraindicaitons |
right atrial tumors, tricuspid vegetations, anticoagulation, compromised pulmonary function,carotid stenosis or previous CEA, newly inserted pace wires |
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Complications with central |
arterial puncture, hematoma, hemothorax, nerve injury, pneumothorax, embolization of catheter or guide wire, arrhythmias, lymphatic, myocardial or central vein perforation, pericardial tamponade, stellate ganglion |
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Infectious , Whats the lowest site for infection |
Lowest site - subclavian** |
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Thombotic |
ICU - 15% of venous thrombosis Femoral>IJ>subclavian |
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Prevention of complications infection |
Chlorhexidine and silver sulfadiazine subclavian sites maximal sterile barrier avoid antibiotic ointments disinfect catheter hubs avoid routine scheduled catheter changes remove when no longer needed |
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Prevention of mechanical complications |
difficult insertion with history, prior surgery or scar, or obesity experienced clinician, avoid femoral cath, manometry, US guidance |
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Central venous catheter IJ |
Patient in Tberg, located carotid artery and place needle lateral point towards nipple locate the triangle formed by the 2 heads of the sternocleidomastoid muscle - be around C6 |
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Subclavian |
continuation of axillary vein deep and parallel to the middle third of clavicle right preferred - dome of right lung lower than left- avoidance of thoracic duct |
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Subclavian setup |
T berg head to contralateral side no finder needle insert needle 1cm below the midpoint of the clavicle advance toward suprasternal notch under the clavicle parallel or 15-20 degree angle to chest puncture at 3-4cm |
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Pulmonary artery catheters indications |
shock state, high vs low pulm edema, diagnosis pulm htn/valve dx/shunts/tamponade/PE monitoring and management of MI therapies MODS |
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Contraindications for PA catheter absolute |
tricuspid or pulmonary valve stenosis tri or pulm valve endocarditis mechanical tri or pulm valves RA or RV masses TOFT ASD |
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Relative indications for PA catheter |
severe arrhythmias, coagulopathy, L heart block, pacer wires RVAD |
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Uses for PA catheter |
assessment of volume when CVP unreliable mixed venous blood to calculate shunt measurement of cardiac output PVR, O2 delivery and uptake, systemic vascular resistance |
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Waveform with PA catheter |
A C and V V waves seen with MR, ischemia, and diastolic dysfunction |
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PA artery waveform |
enters west zone 3 of lung estimate of LA pressure and ultimately LV pressure LAP>RAP Dicrotic notch - pulmonic valve closure |
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PCWP equal to LVEDP except |
mitral stenosis or regurg, aortic regurg, LA myxoma, decreased ventricular compliance, increased ventricular compliance, pulmonary venous obstruction, increased end-expiratory pleural pressure, non-zone 3 placement of catheter |
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Thermodiluation cardiac out put |
10 cc of cold saline - not iced(bradycardia) proximal port measure temp change, |
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Normal PA valves |
CVP 0-7 RV 15-25/0-8 PA15-25/8-15 PCWP 6-12 |
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PA catheter insertion sites and lengths |
RIJ 45-55 LIJ 50-60 cm subclavian 35-50 femoral 65-70 |
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PA catheter features |
Pacing - all types wire catheters for introducing pacing wires continuous SVO2 - detects O2 imbalance before clinical symptoms. tells O2 delivery four determinants - Hgb, CO, SaO2, O2 consumption. |
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Continuous Cardiac output indicated |
immunocompromised, fluid overload, cardiogenic shock. |
