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Hemodynamic monitoring I
Terms in this set (53)
____________ monitoring studies relationships among heart rate, blood flow, oxygen delivery, and tissue perfusion.
What are the typical pressures on the right side of the heart?
Right atrium: 2-6 mmHg
Right ventricle: 15-25 mmHg (systolic); 0-8 mmHg (diastolic)
Pulmonary artery: 15-25 mmHg (systolic); 8-15 mmHg (diastolic)
What are typical pressures on the left side of the heart?
Left atrium: 8-12 mmHg
Left ventricle: 110-130 mmHg (systolic); 8-12 mm Hg (diastolic)
Aorta: 100 - 130 mmHg (systolic); 60-90 mmHg (diastolic)
Regulation of blood flow is determined by:
-Heart rate: can increase or decrease
-Strength of contraction dependent on muscular strength
-Blood vessels diameter
-Degree of turbulence
-Pressure - BP
flow x resistance =
Pressure (measured in mm Hg)
Amount of fluid moved over time
Flow (measured in L/min or mL/min)
Opposition to flow
Volume of blood ejected from heart per minute
Cardiac Output (CO)
HR x Stroke volume
Cardiac Output (CO)
(Stroke volume equals the volume of blood ejected with each beat (4-8 L/min)
% of blood ejected with each beat
Ejection Fraction (normal 60-70%)
Cardiac Index is a more accurate assessment of CO. True or False.
True. CI is based on body size.
SVR stands for
Systemic Vascular Resistance (same as peripheral vascular resistance)
Dependent on the diameter of the blood vessels.
Systemic Vascular Resistance
Normal SVR values
If SVR is lower than 800 dynes, the patient is:
If the SVR is higher than 1200 dynes, the patient is:
CO x SVR =
Degree of cardiac muscle fibers stretch before systole, determine by the volume of blood in ventricle prior to contraction.
Preload = RA = CVP. True or False
Normal right atrium pressure (preload)
Increased stretch = increased volume
Pressure or resistance against flow from left ventricle.
Related to arterial lumen size and blood viscosity
Force overcome by the left ventricle up contraction (Normal: 800 - 1200)
SVR (systemic vascular resistance)
Force overcome by the right ventricle up contraction (Normal: less than 200)
PVR (pulmonary vascular resistance)
Force of ventricular contraction
(measured by CO, CI, or EF)
Noninvasive hemodynamic monitoring modalities
-noninvasive blood pressure
-jugular venous distention
-serum lactate levels (high levels noted in hypo perfusion states, i.e. sepsis)
-urine output (perfusion to kidney)
-color/temp of skin
Invasive hemodynamic monitoring modalities
-arterial pressure monitoring
-pulmonary artery pressure monitoring
-Others (LA Pressure monitoring, brain temp monitoring)
Components of Invasive Hemodynamic Monitoring
-Noncompliant pressure tubing
-Transducer and stopcocks
-Flush system under pressure
For hemodynamic monitoring, where can the catheter be placed?
Artery, vein, or heart
What component of the hemodynamic monitoring system keeps catheter patent?
pressure tubing and flush system (with pressure bag)
What is makes up the flush solution?
Normal saline -or-
Normal saline with one unit heparin/mL of solution
Hemodynamic monitor display will show waveforms for which four areas?
Arterial, atrial, ventricular, pulmonary
Leveled at the patient's right atrium; fourth intercostal space, midaxillary line
The transducer of the hemodynamic monitoring system must be level with the patient's _________
Mean pressure in the arterial bed
Mean Blood Pressure (mBP): most accurate reflection of pressure in the arterial system during both systole and diastole.
2D + Systolic / 3
Invasive technique to monitor arterial blood pressure
Arterial Pressure Monitoring
What sites are used for arterial pressure monitoring?
Radial (complete Allen's test prior to insertion)
Femoral (less desired)
What equipment do you need to put in an Arterial line for pressure monitoring?
-pressurized flush solution with transducer
-pressure bag (pumped to 300 mm Hg to overcome pressure from artery)
-A-line catheter (angiocath)
What patients need intraarterial monitoring?
-receiving vasoactive infusions
-frequent ABGs or lab draws
-Low-flow states (hypotension, sepsis)
-Monitor tx for severe hypertension
Label the following on the graph: systole, end diastole, and the dicrotic notch
Waveform depiction of the closure of the aortic valve
The electrical event happens before the _____ event
Major complications of arterial line pressure monitoring
-Thrombosis (clot if flush not used properly)
Nursing interventions in arterial pressure monitoring:
-Monitor waveform (look out for dampened waveforms)
-Compare values with non invasive BP (A-line should be more accurate; difference of 5 mmHg is normal)
-Maintain intraarterial system
-Check site and circulation to extremities
-Look for signs of infection
Right atrial pressure (RAP) is same as _______
Central venous pressure (CVP)
Catheter in superior or inferior vena cava measures which pressure?
(e.g. Triple lumen, PICC, ScvO2)
RAP is located
in right atrium
Normal value of RAP/CVP
2 to 6 mmHg
RAP/CVP graph (end expiration)
RAP/CVP graph (showing inspiration)
Elevated RA pressures mean:
increased preload (volume overload or R heart failure)
tx: fluid restriction, diuretic
Decreased or low RA pressures mean:
decreased preload (volume depletion)
Complications of RA/CVP monitoring:
-Pneumothorax or hemothorax
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