EKG IVF hemodynamics

hemodynamic monitoring

Monitoring of blood as it moves through the body and the measurement of the pressures it creates

where does the transducer need to be?

at zero level, level of right atrium, also known as phlebostatic axis

where can you find phlebostatic axis?

4th Intercostal Space, Midaxillary

Anytime you reposition pt ; check transducer to make sure it is still at phlebostatic axis or you will get

false readings

Arterial lines (ART lines) are usually found in which arteries ?

radial and femoral

what is purpose of ART line?

BP monitoring and ABG testing

Only type of fluid that can be used with art line is the

fluid flush that is used to keep line from clotting off

what is most common art line spot?

radial artery

how do you get labs from ART line?

discard first 5-10 ml of blood

why do we need ART lines?

to have an accurate BP for vasoactive drugs

Why do we occasionally compare ART line BP to NIBP?

to see if numbers correlate

can a nurse place ART line?

no

what does nursing care of ART line entail?

dressing changes, ensuring patency, removal

if ART line is removed from radial artery how long do you hold pressure ?

5 min

if ART line is removed from femoral artery how long do you hold pressure ?

20 min

what does allens test tell us ?

if we have good arterial blood flow in hand

how is wrist usually positioned for ART line placement ?

hyperextended

what are CMS checks?

checks for circulation , motion , and sensation on extremity with ART line

If arterial line is obstructing perfusion to extremity, it must be

discontinued

what do you do with negative CMS checks?

report to provider

potential complications of ART lines include :

infection, loss of limb, bleeding

what is important to know before ART line removal ?

if pt is on anticoagulants/ blood thinners

what do you do after removing ART line?

place clear dressing over removal site so you can reassess later

Swan Ganz Catheter (SGC) is also called

pulmonary artery catheter

Swan Ganz Catheter (SGC) sits in the ------- artery

pulmonary

Swan Ganz Catheter (SGC) gathers what data?

CVP: Central Venous Pressure

PAP: Pulmonary Artery Pressure

PCWP: Pulmonary Capillary Wedge Pressure

CO: Cardiac Output

CI: Cardiac Index

SVO2: Mixed Venous Oxygen Saturation

Swan Ganz Catheter ; for every place in heart there is a different ----------- so provider can know where tip of catheter is

waveform

Swan Ganz Catheter : every area in heart has a different ---------- associated

pressure

How do we verify placement of Swan Ganz Catheter?

Chest x ray

normal central venous pressure (CVP)

2-8

CVP measures

right atrial pressure , amount of fluid returning to the right side of the heart

how do we obtain central venous pressure ?

PA catheter or central line

Pulmonary Artery Pressure (PAP) measures :

PA systolic , PA diastolic , Pulmonary capillary wedge pressure

normal PA systolic

15-30 mm Hg

normal PA diastolic

8-15 mmHg

Normal pulmonary capillary wedge pressure (PCWP)

8-15 mmHG

Causes of increased PAP (Pulmonary Artery Pressure):

pulmonary HTN

How do we obtain Pulmonary Capillary Wedge Pressure (PCWP)?

Swan Ganz is passed into pulmonary artery , balloon inflated, when waveform flattens catheter is "wedged"

Pulmonary Capillary Wedge Pressure (PCWP) is a reliable indirect measurement of :

left atrial pressure

Pulmonary Capillary Wedge Pressure (PCWP) is only thing that tells us about left side of heart with which catheter ?

Swan Ganz

right sided HF

CVP elevated, PAP- normal, PCWP- normal

left sided HF

CVP, PAP, PCWP- all elevated

pulmonary HTN

CVP- normal, PAP- elevated, PCWP- normal in absence of L-sided HF

hypovolemia

CVP- decreased. PAP- decreased, PCWP- increased

lung issues

CVP- elevated, PAP- elevated, PCWP- normal

SVO2 Mixed Venous Oxygen Saturation is the % of ------ in the blood returning to the right side of the heart

o2

SVO2 Mixed Venous Oxygen Saturation reflects

the body's overall o2 utilization by the tissues

normal SVO2 Mixed Venous Oxygen Saturation value

60-80% (average 75%)

right sided HF

CVP elevated, PAP- normal, PCWP- normal

left sided HF

CVP, PAP, PCWP- all elevated

pulmonary HTN

CVP- normal, PAP- elevated, PCWP- normal

hypovolemia

CVP- decreased. PAP- decreased, PCWP- increased

lung issues - copd , ards, pneumonia

CVP- elevated, PAP- elevated, PCWP- normal

SVO2 Mixed Venous Oxygen Saturation

normal value 60-80% (average 75%)

percentage of 02 in the blood returning to the right side of the heart

Reflects the body's overall O2 utilization by the tissues.

svo2 number will fluctuate based on patients

activity

How often must a central line be flushed?

every 8-12 hours

CVL uses

CVP monitoring, IV fluids, TPN, PPN

how do we confirm CVL placement?

CXR

what is preferred access site for CVL?

subclavian

what CVL site has highest infection risk?

femoral

PICC lines are inserted ---------- , but are still a type of central line

peripherally

Can a PICC line or CVL be used longer ?

PICC Line

PICC line long term uses

abx, TPN

implanted central line

entirely under skin , surgically implanted, useful for long term chronic patients

what type of needle is used to access implanted central line?

huber

how do you dress and clean implanted central line?

sterilely , with central line kit, clear dressing

dialysis catheter

red and blue cap for DIALYSIS Only

high infection risk

trialysis catheter

purple port can be used for fluids and CT contrast

crystalloids

•Intravenous electrolyte solution

•Moves freely between intravascular compartment and interstitial space

colloids

Blood substitutes

Large particles assist fluid to stay within the vascular space

primary fluids run -------

continually

secondary fluids run -----

for a limited period of time

do your secondary fluids go above or below primary?

above

isotonic fluids

NS LR

little to no fluids shift

hypotonic fluids

0.45% NS

fluid moves from vascular space into the cells

what type pts need hypotonic fluids?

DKA, hypernatremia

what are s/s of intravascular collapse

low bp high hr neuro changes

how does intravascular collapse occur?

if hypotonic fluids are given roo fast

what is an indicator of non compilable meds?

precipitation in the lines

SA node

bodys normal pacemaker 60-100 bpm

AV node

"Back-up" if the SA node fails (40-60 bpm)

bundle of HIS

Can also initiate impulses (40-60 bpm)

purkinje fibers

Network of fibers

Carry electrical impulses directly to ventricular muscle cells (20-40 bpm)

p wave

Electrical stimulation of atria to fire (depolorization)

QRS complex

The electrical current signaling ventricles to fire (depolarization)

Much larger than P wave

T wave

Resting phase of the ventricles (repolarization)

smallest boxes

0.04 seconds

larger boxes

0.20 seconds

5 large boxes

1 second strip

15 large boxes

3 seconds

30 large boxes

6 seconds

300 large boxes

1 min

PR interval

time between beginning of the p wave until the beginning of the QRS

typically 0.12 and 0.20 seconds

What does it mean if the PRI is prolonged or >0.20 seconds

Some sort of diseased pathway and there is a delay in impulse travelling from SA node to AV node

QRS

The beginning of the QRS complex to the end of the QRS complex

Normally less than 0.12 seconds in length

Prolongation indicates a diseased normal pathway

problem in AV to bundle of HIS if QRS wider than 0.12 seconds

how many seconds trip do we use to get heart rate?

6 second strip

atrial rate

count p waves

ventricular rate

count QRS complexes

normal hr

60-100

bradycardic rate

<60