Hemodynamics #4

Question 1

Swans: Red Short Pigtail

Answer 1

Controls the balloon and the balloon tip.

-can be used to wedge the catheter and float the cat into place

Question 2

Small blue pigtail

Answer 2

Allows volumes to be infused greater than 2 to 5 mL per hour

• to flush the lines clear end of line
• square wave test (test the dynamic properties of the line and determine damping)

Question 3

Tubing Resonance Frequency

Answer 3

Tubing has high-frequency resonance so low frequency heart rate doesn’t get amplified by the system

Question 4

Transducer level

Answer 4

Needs to be placed level with the phlebostatic axis level with the right atrium - fourth intercostal space mid-auxiliary line
-patient needs to remain on his or her back

Question 5

Zeroing the monitor

Answer 5

Turn stopcock off to the patient

• open up Post to allow atmospheric pressure to enter transducer
• select waveform and zero
• atmospheric pressure no longer contributes to pressure readings on Monitor

Question 6

Square wave test proper dynamic properties

Answer 6

Damping is correct

-determined between two and five bounces after square wave test

Question 7

Square wave test hypodynamic

Answer 7

No bounce noted goes directly back into waveform

• hypodynamic. Muffled reading
• overdamp
• rounded or slurred waveforms

Question 8

Hypodynamic waveform causes

Answer 8

Overdamping caused by air in the line, kinked line,

• increased pressure in pressure bag, failure to Rezero at altitude.
• line more stiff (frozen)
• stop cock closed to patient

Question 9

Square waveform hyperdynamic

Answer 9

More than five bounces after square waveform

-Underdamping

Question 10

Hyperdynamic causes

Answer 10

• too much tubing, distal placement
• pressure bag pressures less than 300
• failing to Re-zero on descent (bag looses pressure)
• less stiff

Question 11

State Anatomic relation w/ arteries, veins nerves and lymphatics

Answer 11

Peripherally moving medial: Nerve, artery, vein, empty space, lymphatics

Question 12

Define Whipping

Answer 12

Exaggerated waveform readings with distal peripheral artery lines.
-caused by inherent dynamic properties of patients extended vascular system between heart and insertion site

Question 13

Allen test negative and positive

Answer 13

Negative: (normal) color returns in 6 seconds
-adequate ulnar blood supply to hand.

Positive (abnormal) color takes longer than 6 sec to return to hand. Inadequate ulnar blood supply.

Question 14

Arterial waveform sharp upslope and dichroic notch.

Answer 14

Sharp upslope: systole (peak represents systolic pressure)
Dicrotic notch: closure of the last heart valve up stream (aortic valve)
(Pulmonic valve is in PA)
-beginning of diastole

Question 15

Slurring of dictotic notch

Answer 15

Aortic stenosis
Notch becomes blended in.
-Elastic properties of valve bounce back against pressure which causes upper deflection In dicrotic notch.
-stenotic valve does not have these elastic properties. No bounce.

Question 16

Acrotic notch

Answer 16

On ascending side.

• also represents aortic stenosis.
• systole occurs initial pressures are not enough to force stenotic valve open and slurs upslope.

Question 17

JGA process of determining high renal flows

Answer 17

Higher flows do not allow adequate time for Na absorption in kidneys. Juxtaglomerular Apparatus sense excess salt, determined higher than normal volume and stimulates elimination of water.

Question 18

JGA process of determining low renal flows

Answer 18

Less filtrate, flow through nephron is reduced. More Na absorbed due to prolonged absorption time. JGA senses lack of salt. Works to increase BP and water reabsorbtion via Renin release.

Question 19

Renin-Angiotensin system

Answer 19

• Renin reacts with angiotensinogen in blood
• angiotensinogen converts to angiotensin I in blood
• Angiotensin I interacts sigh angiotensin converting enzyme (ACE) (found in pulmonary epithelium) and converts to angiotensin II
• Angiotensin II is most potent vasoconstrictor
• circulating angiotensin II stimulates kidneys to release aldosterone
• Aldosterone causes Na/K pumps into high gear. Retains Na and water.

Question 20

Renin-Angiotensin system and cardiogenic shock.

Answer 20

Worsens condition due to sick pump having to overcome increased fluids and vasoconstriction.

• Stretching of atrium promotes release of Atrial Natriuretic Peptide (ANP) aka BNP which interferes w/ aldosterone release.
• can be used to determine degree of heart stretching (CHF primary cause)
• natricore is synthetic ANP (vasodilation & inhibits aldosterone release)

Question 21

Pressure line readings and spontaneous vs ventilated considerations

Answer 21

Should always be assessed at end exhalation

-baseline wonder will reverse axes when change from spontaneous to mechanical ventilation.