What do we monitor and how frequent
Temp, BP, HR, rhythm, O2 sat, ETCO2 Q5M
What is the SBP, DBP, MAP, and pulse pressure
SBP - peak pressure generated during systolic ventricular contraction; reflects myocardial O2 requirements
DBP - trough pressure during diastolic ventricular relaxation; reflects myocardial O2 supply and coronary perfusion pressure
PP - SBP minus DBP
MAP - time weighted pressure during a cardiac cycle; DBP + 1/3 SBP
Indication of A-line insertion
- continuous blood pressure monitoring
- hypotension that is undetectable from NIBP
- anticipated swings in HD during induction
- large volume fluid shifts
- titration of vasoactive drugs
- shock
- repeating blood samples
- failure of indirect BP measurements
CVC indications
- vasoactive medications
- vessicant medications
- long term ABX
- TVP
- PAP
- CVP monitoring
- intermittent HD
- air aspiration
CVC placement
- SVC/RA junction, parallel to vessel wall, below level of clavicle, above level of the rib, at the T4T5 interspace and the carina
CVC complications
- vascular injury, cardiac tamponade, hematoma, pneumothorax, nerve injury, arrhythmia, thrombosis, P.E, infection
CVP events
A wave C wave X descent V wave Y descent
A wave
Atrial contraction
Corresponds with P wave
End diastole
Corresponds with atrial kick
C wave
- occurs during isovolumetric contraction
- tricuspid valve bulges into atrium
- early systole
- occurs right after QRS
X descent
- Atrial relaxation
- mid systole
V wave
- ventricular ejection
- passive filling of RA with TV closed
- late systole
- occurs just after T-wave
Y descent
- TV opens
- passive filling of ventricle
What does a PAC measure
- intracardiac pressure
- LV filling pressures
- CO/CI
- mixed venous
- SVR/PVR
- can pace
Describe swan
- 4 ports
- 7 French
- distal port PAP
- second port CVP
- 3rd port balloon
- 4th port temp/pacer
PCWP waveform
A wave
C wave
V wave
A wave
- contraction of left atrium
- normally small, larger if MS
C wave
- early systole
- mitral valve bulges in LA
V wave
- LA passively fills from pulmonary veins
- prominent v wave is mitral insufficiency
Indications for TEE in the OR
- ischemia
- valvular function
- valvular dysfunction
- P.E
- dissection
- hypotension
- tamponade
Complications of TEE
- hoarseness
- esophageal trauma
- arrhythmias
- dysphagia
