Hemodynamics, LINES, CO/CI and etc.

CVPS, LINES, CO/CI and etc.

phlebostatic axis

4th intercostal space, mid axillary line.

This is where we level to zero lines to ensure accurate numbers. This can be accomplished with the pt lying supine or HOB at 45. Lines should be zeroed every 4 hrs. this is level with the right atrium

CVP/RAP

central venous pressure or right atrial pressure. preload

what does CVP measure

estimates central venous blood/fluid volume

right heart function

how can CVP be affected?

decreased cardiac output, forced exhalation, HF, hypovolemia, PEEP, pleural effusion, PE, fluid status

what is PAP

pulmonary artery pressure

what does PAP measure?

left ventricular filling pressures.

Displayed like a BP normal sys: 15-25mmhg normal diastolic: 8-15 mmhg

how can PAP be affected?

decreased- hypovolemia

increased - hypervolemia, left ventricular failure

SVR

systemic vascular resistance and afterload

what does SVR measure?

measures the resistance in the circulatory system that is used to create blood pressure

how can SVR be affected?

vasoconstriction/vasodilation, plaque, afterload

what is cardiac index?

Cardiac output divided by body surface area. This gives us a more patient specific number

how can cardiac index be affected?

This can be affected by preload, after load, contractility, and the patient's body surface area.

what is cardiac output?

heart rate x stroke volume

how can cardiac output be affected?

This can be affected by after load, pre load, contractility. decreased HR or SV

What invasive lines can be used to measure hemodynamics?

arterial line

pulmonary artery catheter (swan Ganz)

right arterial pressure monitoring

central venous catheter

arterial line

Provide continuous BP readings and can be used for arterial blood samples.

pulmonary artery catheter purpose

Assess left ventricular function, assess pt's hemodynamic response to drugs and fluid

where are arterial lines placed?

In the radial (most common), brachial, or femoral artery

what is important to monitor with arterial lines?

circulation of the limb

can arterial lines be used for IV infusions?

no

how is pulmonary artery catheters placed?

threaded through the right side of the heart into a branch of the pulmonary artery

What is the nursing care for a patient with an invasive line?

Assist with line insertion, monitor respiratory and cardiac status, maintain line patency and integrity, obtain hemodynamic readings from catheter, prevent infection.

What hemodynamic changes may occur with dysrhythmias?

low SV, CO, BP

What is included in the assessment of the patient with dysrhythmias/signs of altered cardiac output?

changes in LOC, chest pain, hypotension, weak pulses, fatigue, SOB, crackles, dizzy, restlessness

what invasive lines can cause dysrhythmias?

PAC + PVC

these lines can tickle the heart and cause PA rupture or infarction

complications of invsasive monitoring

-thrombosis- flush the lines appropriately

-embolism- air entering system/clot dislodgment

-hemorrhage- loose connections/catheter dislodgment

-infection -cardiac tamponade

complications of CVP monitoring

infection, thrombosis, air embolism, pneumothorax, blood loss

Right preload

CVP (central venous pressure)

left preload

PAWP (pulmonary artery wedge pressure)

Preload

volume of blood in ventricles at end of diastole

what affects preload

breathing

atrial kick

amount of circulating volume

condition of vascular system

how is preload measured?

skin turgor

cap refill

CVP

afterload

The force or resistance against which the heart pumps.

what effects afterload?

condition of vascular system

-dilated vs constricted

-leaky

-drugs

how is afterload measured?

PVR and SVR

PVD

how do you prevent complications of an arterial line?

ensure all tubing connections are tightened. Loose connections can cause hemorrhage

what does the PR interval and QRS measure?

PR: 0.12-0.20

QRS: 0.06-0.12

left afterload

SVR

right after-load

PVR

What drugs decrease preload?

diuretics

nitro