W11. CVP - Combined NEW!

What is the primary purpose of monitoring and life support in acute care?

To interpret settings, displays, and patient data to make informed clinical decisions

Why is monitoring equipment becoming more relevant outside the ICU?

Because acute hospital stays are decreasing, so this equipment is moving into long-term care, inpatient rehab, and home health settings

What 3 broad areas are included in monitoring and life support content?

Noninvasive monitoring, invasive monitoring, and respiratory/cardiac life support

How many electrodes are used to create a 12-lead ECG?

10 electrodes

How do 10 electrodes create 12 ECG leads?

4 limb electrodes create 6 limb leads, and 6 chest electrodes create 6 chest leads

What does a bedside cardiac monitor commonly display?

An ECG waveform, an SpO2 waveform, a respiratory waveform, heart rate, oxygen saturation, and respiratory rate

Why is lead management important during movement?

Because leads can detach during activity and create misleading monitor readings

What can a detached ECG lead look like on a monitor?

It can falsely appear as asystole or a flatline

What rhythm changes should a PT watch for on the monitor during activity?

ST-segment changes, multiple PVCs or a change in PVC focus, ventricular tachycardia, ventricular fibrillation, and worsening heart block

Which bedside vital sign is not always measured continuously?

Blood pressure

What does SpO2 measure?

Arterial oxygen saturation as the percentage of oxygen bound to hemoglobin

Where can a pulse oximeter sensor be placed?

On the finger, toe, or earlobe

What SpO2 level should generally be maintained?

Above 90%

Why might a PT titrate oxygen during activity?

To keep the patient’s oxygen saturation above the ordered or safe threshold, often above 90%

Why can low perfusion make a pulse oximeter inaccurate?

Because the pulse oximeter needs a strong pulsatile blood-flow signal, and low perfusion makes that signal weak

What can interfere with pulse oximeter readings?

Anemia or low perfusion, nail polish, fluorescent light, jaundice, darker skin pigmentation, and arrhythmias

How can arrhythmias affect pulse oximeter accuracy?

They create irregular pulsatile signals, which makes the device harder to calculate consistently

Why should a PT manually take the pulse during the first assessment instead of relying only on the pulse oximeter?

Because the pulse oximeter cannot reliably detect arrhythmias or heart disease

What is the normal resting adult heart rate range?

50 to 100 beats per minute

What is the normal resting adult systolic blood pressure range?

85 to 140 mm Hg

What is the normal resting adult diastolic blood pressure range?

40 to 90 mm Hg

What is the normal resting adult respiratory rate range?

12 to 20 breaths per minute

What is the normal resting adult oxygen saturation range?

Greater than 95%

How often are automated blood pressure machines commonly set to cycle?

Usually every 5 to 15 minutes depending on patient acuity

What should a PT bring when mobilizing a patient whose blood pressure is being measured by an automated machine?

A manual blood pressure cuff and stethoscope

Why is a manual blood pressure cuff needed during mobility?

Because the automated machine does not move with the patient

What is an arterial line used for?

Continuous blood pressure monitoring and frequent arterial blood gas sampling in unstable patients

What is the normal MAP range?

70 to 110 mm Hg

What does a MAP below 60 mm Hg suggest?

Poor organ perfusion

Where should the arterial line transducer be positioned for accurate readings?

At the level of the right atrium

What happens if the arterial line transducer is too high?

The blood pressure reads falsely low

What happens if the arterial line transducer is too low?

The blood pressure reads falsely high

What are the most common arterial line placement sites?

Radial and femoral

What is an important precaution with a radial arterial line?

Limit or avoid weight-bearing through that wrist

What should you do if an arterial line becomes dislodged?

Apply firm direct pressure immediately because it can cause massive blood loss

What does a central line measure?

Central venous pressure, which reflects right atrial pressure

Where are central lines commonly inserted?

Into the subclavian or internal jugular veins

Why are some medications given through a central line instead of smaller veins?

Because they may be too irritating or toxic to smaller vessels

What is the difference between tunneled and non-tunneled central lines?

Tunneled lines are used for longer-term access, while non-tunneled lines are used short term

What does PICC stand for?

Peripherally Inserted Central Catheter

Where is a PICC line inserted, and where does it end?

It is inserted into the cephalic, basilic, or brachial vein and ends in the superior vena cava

What are important precautions with central lines and PICC lines during mobility?

Keep them sterile, secure the ends, avoid compression, and avoid dislodging them

What is a Swan-Ganz catheter also called?

A pulmonary artery catheter

Where is a Swan-Ganz catheter threaded?

Through a central vein, then the right atrium and right ventricle, into the pulmonary artery

What measurements can a Swan-Ganz catheter help obtain?

• Central venous pressure (R atria/preload)

• R atrial pressure

• Pulmonary artery pressure

• Pulmonary capillary wedge pressure (L atria/preload)

What does pulmonary capillary wedge pressure estimate?

Left-sided heart filling pressure and left ventricular function

What are common uses of Pulmonary Capillary Wedge Pressure (PCWP)?

Estimates (indirect) L side heart filling pressure and L ventricular function

• Monitoring heart function after surgery

• Diagnosing chronic heart failures

• Differentiating causes of pulmonary edema

• Guiding diuretic dosing

What can an elevated pulmonary capillary wedge pressure suggest?

Pulmonary hypertension or resistance to blood flow into the left ventricle

How can a Swan-Ganz catheter help with dyspnea evaluation?

It can help differentiate cardiac from non-cardiac causes of dyspnea

What complications can happen if a Swan-Ganz catheter is dislodged?

Serious arrhythmia, pulmonary artery rupture, pulmonary valve damage, and infection of the heart

Can stable patients mobilize with a Swan-Ganz catheter?

Yes, mobilization can be safe if the patient is stable and the line is properly secured

What routes for temperature monitoring are listed?

Swan-Ganz catheter, urinary catheter, nasopharyngeal route, and rectal probe

When is a rectal probe typically used for temperature monitoring?

When the patient is comatose, intubated, or confused

In what kinds of patients is intracranial pressure monitoring used?

Patients with brain surgery, head injury, hemorrhage, tumors, or meningitis

Why is high intracranial pressure dangerous?

Because it decreases brain perfusion

How can low CO2 affect intracranial pressure?

Low CO2 can help control increased intracranial pressure

What can be placed to help control increased intracranial pressure?

A drain or shunt

What is the PT’s role with a patient who has high intracranial pressure?

To assess tolerance and response to position changes and early mobilization

What is the typical flow range for a nasal cannula?

1 to 6 L/min

How does FiO2 change with a nasal cannula?

Each 1 L/min of oxygen increases FiO2 by about 4%

When should oxygen from a nasal cannula be humidified?

When flow is greater than 4 L/min

What is the typical flow range and FiO2 range for a simple face mask?

About 5 to 10 L/min and roughly 35% to 56% FiO2

Why must a trach mask be humidified?

Because it bypasses the upper airway, which normally helps humidify inspired air

What is a Venturi mask used for?

To deliver a very precise FiO2 using color-coded adapters

Why is a Venturi mask helpful clinically?

Because it is used when a specific oxygen concentration needs to be delivered accurately

How does a non-rebreather mask work?

The reservoir bag fills with oxygen, and the patient breathes from the bag through a one-way valve that limits mixing with room air

How much oxygen can a non-rebreather mask provide?

Up to 100% oxygen

What is an important setup rule for a non-rebreather mask?

The reservoir bag must stay fully inflated

What extra planning is needed when mobilizing a patient on a non-rebreather mask?

Start with a full oxygen tank and bring a spare because the flow rate is high

What is the typical flow range for a high-flow nasal cannula?

25 to 60 L/min

How does high-flow nasal cannula help the lungs?

It creates positive expiratory pressure that helps splint the airways open and recruit more lung surface area for gas exchange

How are common oxygen delivery systems generally ordered from lower to higher support?

Nasal cannula, Venturi mask, non-rebreather mask, high-flow nasal cannula

What does CPAP stand for?

Continuous positive airway pressure

How does CPAP work?

It provides one constant positive pressure during both inhalation and exhalation

What is CPAP commonly used for?

Sleep apnea

What does BiPAP stand for?

Bilevel positive airway pressure

How does BiPAP differ from CPAP?

BiPAP provides 2 pressure levels, IPAP and EPAP, while CPAP provides 1 constant pressure

When is BiPAP often used?

To help wean patients from ventilators or prevent intubation

Are CPAP and BiPAP more or less supportive than a ventilator?

They are less supportive than a ventilator

What are the main indications for invasive mechanical ventilation?

Failure to oxygenate, failure to ventilate, a combination of both, or need for airway protection

What are the 2 main invasive airway types used for mechanical ventilation?

An endotracheal tube and a tracheostomy tube

Which invasive airway is usually short term?

An endotracheal tube

Which invasive airway is usually longer term?

A tracheostomy tube

What is tidal volume on a ventilator?

The amount of air delivered with each breath

What is PEEP on a ventilator?

Positive end-expiratory pressure that keeps alveoli from collapsing and improves gas exchange time

How does higher PEEP affect the lungs?

It helps splint the airways open and gives more time for gas exchange

What does FiO2 mean on a ventilator?

The percentage of oxygen in the delivered air

What FiO2 goal is preferred for long-term use?

Keep FiO2 under 50% if possible

Why is prolonged FiO2 above 50% a concern?

Because it can cause oxygen toxicity and lung damage such as atelectasis

What is control mode on a ventilator?

A mode in which the machine has complete control, blocks spontaneous breaths, and delivers the set volume and respiratory rate

What is assist-control ventilation (AC-VC)?

A mode in which the machine delivers a preset volume with each breath, and the patient can initiate extra breaths that are also fully assisted to that preset volume

What is synchronized intermittent mandatory ventilation (SIMV-VC)?

A mode with a set respiratory rate and tidal volume for mandatory breaths, but extra patient-initiated breaths are not volume controlled

What is spontaneous or pressure support ventilation?

A mode in which the patient initiates the breath and determines the volume and respiratory rate, while the machine provides pressure support to overcome airway resistance

Which ventilator mode gives the patient the most independence?

Spontaneous or Pressure Support

What type of procedure is a median sternotomy typically used for?

Cardiac procedures

What is a major implication of median sternotomy for rehabilitation?

Significant chest pain and possible thoracic spine issues due to rib compression during retraction

What is a posterolateral thoracotomy commonly used for?

Pulmonary procedures such as lung resections, hemothorax, or pneumothorax

Why is a posterolateral thoracotomy often difficult for patients after surgery?

• Significant pain

• Impaired chest mobility

• Pulmonary issues

Which muscles are divided in a posterolateral thoracotomy?

Lower trapezius, serratus anterior, and latissimus dorsi

What is an important clinical tradeoff with the muscle-sparing version of a posterolateral thoracotomy?

It gives better functional results but less visibility for the surgeon