Hemodynamics

Question 1

2 things Validity must have

Answer 1

Consistency
Integrity (accurate data) - nurse’s responsibility

Question 2

*Equation for pressure

Answer 2

Pressure = flow X resistance
*(Increased flow &/or resistance = increased pressure)
*(increased volume = increased pressure)

Question 3

Common types of hemodynamic monitoring

Answer 3

• Arterial pressure monitoring (Art line)
• Pulmonary artery pressure monitoring (PA catheter; Swan Ganz)
• Right atrial pressure monitoring (RAP or CVP: central venous pressure)

Question 4

What does the transducer do?

Answer 4

Converts physiological events into electrical signals

Question 5

What does the amplifier do?

Answer 5

Picks up electrical signal and transmits to display through cable

Question 6

What should the bag be pressurized at for hemodynamic monitoring?

Answer 6

300 mm Hg to keep line open

Question 7

*What is the nurse responsible for when taking care of a hemodynamic monitoring device?

Answer 7

Level
Balance
Calibration

Question 8

What is the level called? where is it?

Answer 8

Phlebostatic axis (4th ICS MAL) - where the transducer is leveled (transducer should be on IV pole, kept at this level)

Question 9

What is the balance?

Answer 9

Zero reference (negates atmosphere pressure) - button on machine to take away atmosphere pressure

Question 10

Why is calibration done?
How is it done?
When is it done?

Answer 10

For numerical accuracy

done with a *square wave test:
- 1x per shift
- during position changes
- after blood draw

Question 11

Indications for intraarterial monitoring (minute to minute BP monitoring)

Answer 11

• Continuous BP monitoring (severe hyper/hypotension)
• Blood drawing
• Vasopressor infusions

Question 12

Sites for intraarterial monitoring:

Answer 12

Radial = preferred
Brachial
Femoral (no longer recommended)

Question 13

Nursing consideration for radial intraarterial monitoring

Answer 13

Perform Allen test for circulation: to make sure ulnar artery is open & functional incase radial is damaged from this

Question 14

**Nursing responsibilities for Intraarterial Monitoring

Answer 14

• Monitor waveform
• Compare values with BP cuff (A-line should be more accurate)
• Check connections in system
• Check site and circulation to extremities (q2hr)
• Set alarms
• Hold pressure for at least 5 min when dc’d (femoral at least 20 min)
• Infection control
• Maintain patency of system

Question 15

Infection control nursing considerations for intraarterial monitoring

Answer 15

• change dressing/bag/tubing per protocol
• document dates for insertion/dsg changes
• assess for s/s of infection q4hr
• limit disconnecting system/sterile caps (keep system closed as much as possible)

Question 16

Nursing considerations to maintain patency of system for intraarterial monitoring

Answer 16

• flush after each use
• maintain pressure of 300 mm Hg
• ensure adequate amount of flush solution

Question 17

How much blood should be drawn from A-line and discarded?

Answer 17

3-10 mL, depends on hospital policy

Question 18

Possible complications for intraarterial monitoring

Answer 18

Air Embolus = major complication (keep connections tight to avoid)
Hemorrhage (keep connections tight to avoid)
Thrombosis
Infection

Question 19

Another name for Right Atrial Pressure

Answer 19

CVP

Question 20

What does right atrial pressure measure?

Answer 20

RV preload / RVEDP

Question 21

What is preload?

Answer 21

Volume of blood in right ventricle just prior to systole

Question 22

*What does preload affect?

Answer 22

*Stroke volume and cardiac output

Question 23

Normal CVP

Answer 23

0-8

Question 24

*Interpretation for if CVP is low:

Answer 24

1st think: *Hypovolemia
Tx: give fluids (prob IV, like saliene bolus)
If no improvement in output/CVP: *Vasodilation
Tx: vasopressor like: norepi (Levafed)

Question 25

*Interpretation for if CVP is high

Answer 25

1st think: *hypervolemia Tx: diuretics (furosemide) If doesnt work think: *vasoconstriction (pt in shock) Tx: vasodilator like nitroglycerin or nitropresside OR *right CHF OR *pulmonary hypertension

Question 26

Function of pulmonary artery catheter (swan ganz)

Answer 26

*Reflects left heart pressures Can also measure cardiac output *Wedge pressure aka *PA pressure aka *PCWP

Question 27

Nurse’s job during insertion of PA catheter

Answer 27

Monitor pressures in each chamber Record values Assess for complications (dysrhythmias/pneumo/hemothorax)

Question 28

*Interpretation of increased PA pressures

Answer 28

1st think: *volume overload (CHF) Tx: diuretics 2nd think: vasoconstriction Tx: vasodilators

Question 29

*Interpretation of decreased PA pressures

Answer 29

1st think: *volume depletion Tx: correct IV fluids 2nd think: vasodilation Tx: correct with vasoconstrictor

Question 30

What does TEE stand for?

Answer 30

Transesophageal echo

Question 31

What is an esophageal Doppler? What does it do?

Answer 31

Thin silicone probe placed in distal esophagus to evaluate descending aortic blood flow (LV function)