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Questions and Answers
During which phase of the cardiac cycle does the anacrotic limb of the arterial waveform occur?
During which phase of the cardiac cycle does the anacrotic limb of the arterial waveform occur?
- Atrial systole
- Atrial diastole
- Ventricular systole (correct)
- Ventricular diastole
What event in the cardiac cycle is directly responsible for the dicrotic notch observed in the arterial waveform?
What event in the cardiac cycle is directly responsible for the dicrotic notch observed in the arterial waveform?
- Closing of the tricuspid valve
- Closing of the aortic valve (correct)
- Opening of the mitral valve
- Opening of the aortic valve
Which component of the arterial waveform represents the point of maximal pressure during ventricular contraction?
Which component of the arterial waveform represents the point of maximal pressure during ventricular contraction?
- Peak systolic pressure (correct)
- Baseline
- Anacrotic limb
- Dicrotic limb
A patient's arterial waveform shows a significantly reduced dicrotic notch. Which of the following is the most likely cause?
A patient's arterial waveform shows a significantly reduced dicrotic notch. Which of the following is the most likely cause?
Which of the following occurs during the systole phase of the cardiac cycle?
Which of the following occurs during the systole phase of the cardiac cycle?
The baseline of the arterial waveform corresponds to which pressure measurement and phase of the cardiac cycle?
The baseline of the arterial waveform corresponds to which pressure measurement and phase of the cardiac cycle?
If a patient's systolic pressure is 150 mmHg and diastolic pressure is 90 mmHg, what is their pulse pressure?
If a patient's systolic pressure is 150 mmHg and diastolic pressure is 90 mmHg, what is their pulse pressure?
During which of the following conditions would you expect to see an elevated diastolic pressure in the arterial waveform?
During which of the following conditions would you expect to see an elevated diastolic pressure in the arterial waveform?
Which of the following events marks the beginning of ventricular diastole?
Which of the following events marks the beginning of ventricular diastole?
A patient's arterial waveform shows a very slow and gradual anacrotic limb. What condition might this suggest?
A patient's arterial waveform shows a very slow and gradual anacrotic limb. What condition might this suggest?
A patient's heart rate is 80 beats per minute, and their stroke volume is 70 mL/beat. What is their cardiac output in L/min?
A patient's heart rate is 80 beats per minute, and their stroke volume is 70 mL/beat. What is their cardiac output in L/min?
A patient has a blood pressure of 130/80 mm Hg. What is their approximate Mean Arterial Pressure (MAP)?
A patient has a blood pressure of 130/80 mm Hg. What is their approximate Mean Arterial Pressure (MAP)?
Which set of hemodynamic values falls within normal ranges?
Which set of hemodynamic values falls within normal ranges?
A patient's MAP is consistently below 70 mm Hg. Which physiological consequence is most likely to occur?
A patient's MAP is consistently below 70 mm Hg. Which physiological consequence is most likely to occur?
After removing a central line, what is the most important immediate nursing intervention?
After removing a central line, what is the most important immediate nursing intervention?
Which calculation requires both systolic and diastolic blood pressure values?
Which calculation requires both systolic and diastolic blood pressure values?
A patient's cardiac index is 1.8 L/min/m². Which of the following conditions is most likely contributing to this finding?
A patient's cardiac index is 1.8 L/min/m². Which of the following conditions is most likely contributing to this finding?
Following removal of an arterial line, what assessment is most critical in the first hour?
Following removal of an arterial line, what assessment is most critical in the first hour?
Why is sterile technique emphasized during central line catheter removal?
Why is sterile technique emphasized during central line catheter removal?
When assessing a central line system, which of the following actions is of greatest importance in preventing CLABSI?
When assessing a central line system, which of the following actions is of greatest importance in preventing CLABSI?
Following arterial line removal, which of the following steps is most critical to ensure patient safety?
Following arterial line removal, which of the following steps is most critical to ensure patient safety?
What is the primary reason for consistently assessing central lines?
What is the primary reason for consistently assessing central lines?
Which action is least likely to be associated with preventing a Central Line-Associated Bloodstream Infection (CLABSI)?
Which action is least likely to be associated with preventing a Central Line-Associated Bloodstream Infection (CLABSI)?
After inserting an arterial line, what immediate assessment is most crucial for evaluating its functionality and the patient's safety?
After inserting an arterial line, what immediate assessment is most crucial for evaluating its functionality and the patient's safety?
A patient with a central line suddenly develops a fever, and the insertion site appears red and tender. What is the most appropriate initial nursing intervention?
A patient with a central line suddenly develops a fever, and the insertion site appears red and tender. What is the most appropriate initial nursing intervention?
What is the significance of using sterile gloves during central line catheter removal?
What is the significance of using sterile gloves during central line catheter removal?
During diastole, what key events occur in the heart?
During diastole, what key events occur in the heart?
What does the 'a' wave in the right atrial pressure (RAP) waveform represent?
What does the 'a' wave in the right atrial pressure (RAP) waveform represent?
The 'v' wave in the CVP/RAP waveform corresponds with what?
The 'v' wave in the CVP/RAP waveform corresponds with what?
What mechanical event does the 'c' wave in the right atrial pressure (RAP) waveform correlate with?
What mechanical event does the 'c' wave in the right atrial pressure (RAP) waveform correlate with?
What physiological process is represented by the 'y' descent on the right atrial waveform tracing?
What physiological process is represented by the 'y' descent on the right atrial waveform tracing?
When performing waveform analysis, what is the relationship between the ECG and RAP tracings?
When performing waveform analysis, what is the relationship between the ECG and RAP tracings?
During which phase of respiration should waveforms be measured for accuracy, and why?
During which phase of respiration should waveforms be measured for accuracy, and why?
Which of the following is essential for accurate measurement of waveforms?
Which of the following is essential for accurate measurement of waveforms?
Considering the relationship between CVP waveforms and ECG, the 'a' wave on the CVP tracing aligns with which portion of the ECG?
Considering the relationship between CVP waveforms and ECG, the 'a' wave on the CVP tracing aligns with which portion of the ECG?
The 'c' wave on a CVP tracing approximately lines up with which portion of the ECG?
The 'c' wave on a CVP tracing approximately lines up with which portion of the ECG?
The 'v' wave on a CVP tracing occurs in conjunction with which portion of the ECG?
The 'v' wave on a CVP tracing occurs in conjunction with which portion of the ECG?
Which factor is crucial when analyzing right atrial waveforms to ensure accuracy?
Which factor is crucial when analyzing right atrial waveforms to ensure accuracy?
How would a fever likely influence central venous pressure (CVP), and why?
How would a fever likely influence central venous pressure (CVP), and why?
How does pericarditis typically affect central venous pressure (CVP)?
How does pericarditis typically affect central venous pressure (CVP)?
Following a cardiac tamponade, which of the following is most likely to be observed on the CVP waveform?
Following a cardiac tamponade, which of the following is most likely to be observed on the CVP waveform?
A patient with a history of heart failure (HF) is admitted with shortness of breath and edema. Based on the provided information, what change in Central Venous Pressure (CVP) would you expect to observe?
A patient with a history of heart failure (HF) is admitted with shortness of breath and edema. Based on the provided information, what change in Central Venous Pressure (CVP) would you expect to observe?
A patient presents with severe dehydration following prolonged vomiting and diarrhea. Which of the following hemodynamic changes is most likely to be observed?
A patient presents with severe dehydration following prolonged vomiting and diarrhea. Which of the following hemodynamic changes is most likely to be observed?
A patient is diagnosed with pulmonary hypertension. Which of the following hemodynamic parameters is most likely to be elevated?
A patient is diagnosed with pulmonary hypertension. Which of the following hemodynamic parameters is most likely to be elevated?
A patient is admitted with septic shock. Initial assessment reveals significant vasodilation. What change in Systemic Vascular Resistance (SVR) would be expected?
A patient is admitted with septic shock. Initial assessment reveals significant vasodilation. What change in Systemic Vascular Resistance (SVR) would be expected?
A patient with a tension pneumothorax is being monitored. What effect would this condition likely have on Central Venous Pressure (CVP)?
A patient with a tension pneumothorax is being monitored. What effect would this condition likely have on Central Venous Pressure (CVP)?
A patient is receiving vasopressor medications to increase blood pressure. What effect would this intervention likely have on Systemic Vascular Resistance (SVR)?
A patient is receiving vasopressor medications to increase blood pressure. What effect would this intervention likely have on Systemic Vascular Resistance (SVR)?
A patient with COPD is being evaluated for pulmonary hypertension. How does COPD contribute to elevated Pulmonary Artery Pressure (PAP)?
A patient with COPD is being evaluated for pulmonary hypertension. How does COPD contribute to elevated Pulmonary Artery Pressure (PAP)?
A patient experiencing anaphylactic shock is exhibiting severe hypotension. Which of the following hemodynamic changes is most likely contributing to this?
A patient experiencing anaphylactic shock is exhibiting severe hypotension. Which of the following hemodynamic changes is most likely contributing to this?
A patient diagnosed with aortic stenosis is being monitored for changes in Systemic Vascular Resistance (SVR). How does aortic stenosis affect SVR?
A patient diagnosed with aortic stenosis is being monitored for changes in Systemic Vascular Resistance (SVR). How does aortic stenosis affect SVR?
A patient is admitted with neurogenic shock following a spinal cord injury. What is the primary mechanism by which neurogenic shock leads to decreased Systemic Vascular Resistance (SVR)?
A patient is admitted with neurogenic shock following a spinal cord injury. What is the primary mechanism by which neurogenic shock leads to decreased Systemic Vascular Resistance (SVR)?
A patient with pericarditis is being monitored for changes in Central Venous Pressure (CVP). How does pericarditis influence CVP?
A patient with pericarditis is being monitored for changes in Central Venous Pressure (CVP). How does pericarditis influence CVP?
During the initial phase of septic shock, a patient's blood pressure drops significantly despite fluid resuscitation. What is the most likely cause of this persistent hypotension?
During the initial phase of septic shock, a patient's blood pressure drops significantly despite fluid resuscitation. What is the most likely cause of this persistent hypotension?
A patient is given a medication that stimulates the parasympathetic nervous system. What effect would you expect to see on the patient's Systemic Vascular Resistance (SVR)?
A patient is given a medication that stimulates the parasympathetic nervous system. What effect would you expect to see on the patient's Systemic Vascular Resistance (SVR)?
A patient's hemodynamic monitoring shows a high Pulmonary Artery Pressure (PAP). Which of the following conditions is least likely to contribute to this finding?
A patient's hemodynamic monitoring shows a high Pulmonary Artery Pressure (PAP). Which of the following conditions is least likely to contribute to this finding?
A patient is hemorrhaging due to a traumatic injury. Which hemodynamic parameter would you expect to decrease initially?
A patient is hemorrhaging due to a traumatic injury. Which hemodynamic parameter would you expect to decrease initially?
Flashcards
Anacrotic Limb
Anacrotic Limb
The initial, steep rise in the arterial waveform when the aortic valve opens and blood is ejected into the aorta.
Systolic Pressure
Systolic Pressure
The peak of the anacrotic limb, representing the highest pressure during ventricular contraction.
Dicrotic Limb
Dicrotic Limb
The gradual decline in the arterial waveform following the systolic peak, representing continued blood ejection at a reduced force.
Dicrotic Notch
Dicrotic Notch
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Diastolic Pressure
Diastolic Pressure
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Systole
Systole
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Systole Events
Systole Events
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Cardiac Output (CO)
Cardiac Output (CO)
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Cardiac Output Equation
Cardiac Output Equation
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Normal Cardiac Output
Normal Cardiac Output
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Mean Arterial Pressure (MAP)
Mean Arterial Pressure (MAP)
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Normal MAP Range
Normal MAP Range
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MAP Calculation
MAP Calculation
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Normal CVP Range
Normal CVP Range
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Normal Cardiac Index
Normal Cardiac Index
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Central Line Assessment
Central Line Assessment
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CLABSI Prevention
CLABSI Prevention
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Sterile Gloves
Sterile Gloves
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Post-Removal Pressure
Post-Removal Pressure
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Arterial Line Site Check
Arterial Line Site Check
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Arterial Line Insertion
Arterial Line Insertion
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Post-Arterial Line Pressure
Post-Arterial Line Pressure
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Post-Removal Monitoring
Post-Removal Monitoring
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CVP/RAP
CVP/RAP
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CVP/RAP increase in HF?
CVP/RAP increase in HF?
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Hypovolemia effect on CVP/RAP?
Hypovolemia effect on CVP/RAP?
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Pericarditis effect on CVP/RAP?
Pericarditis effect on CVP/RAP?
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Vasodilation effect on CVP/RAP?
Vasodilation effect on CVP/RAP?
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PA
PA
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Pulmonary HTN effect on PA?
Pulmonary HTN effect on PA?
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Left HF effect on PA?
Left HF effect on PA?
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COPD effect on PA?
COPD effect on PA?
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Hypovolemia effect on PA?
Hypovolemia effect on PA?
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Vasodilation effect on PA?
Vasodilation effect on PA?
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SVR
SVR
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HTN effect on SVR?
HTN effect on SVR?
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Sepsis impact on SVR?
Sepsis impact on SVR?
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Vasoconstriction effect on SVR?
Vasoconstriction effect on SVR?
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Diastole
Diastole
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Right Atrial Waveform (CVP/RAP)
Right Atrial Waveform (CVP/RAP)
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A Wave (CVP)
A Wave (CVP)
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C Wave (CVP)
C Wave (CVP)
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V Wave (CVP)
V Wave (CVP)
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X Descent
X Descent
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Y Descent
Y Descent
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Waveform Analysis
Waveform Analysis
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End-expiration
End-expiration
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Measuring Waveforms Accurately
Measuring Waveforms Accurately
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CVP 'a' wave timing
CVP 'a' wave timing
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CVP 'c' wave timing
CVP 'c' wave timing
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CVP v wave timing
CVP v wave timing
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CVP 'a' wave reference
CVP 'a' wave reference
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PCWP 'c' wave reference
PCWP 'c' wave reference
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Study Notes
- Cardiac cycle phases include systole and diastole
Arterial Waveform Components
- Anacrotic limb occurs when the aortic valve opens and blood flows into the aorta, indicated by a steep upstroke
- The top of the anacrotic limb represents peak/highest systolic pressure, normally between 100-140 mmHg
- Dicrotic limb represents systolic ejection of blood that's continuing at a reduced force; waveform descends during this phase
- Dicrotic notch corresponds to the closure of the aortic valve and the beginning of ventricular diastole and disrupts the dicrotic limb
- Baseline represents diastolic pressure, typically between 60-80 mmHg, and is the lowest portion of the arterial waveform
Cardiac Cycle Phases
- Systole includes atrial relaxation, ventricular contraction, tricuspid and mitral valve closure, and ejection of blood from ventricles
- Diastole involves atrial contraction, ventricular relaxation, and passive filling of ventricles through open tricuspid and mitral valves
Right Atrial Waveform (CVP/RAP)
- Undulating pattern with 3 positive and 2 negative excursions
- Undulations represent mechanical events in the cardiac cycle
Positive Waves
- "a wave": Atrial systole/contraction, leads to increase in atrial pressure during the PR interval
- "c wave": Closure of tricuspid valve in early systole, normally at the end of the QRS complex but not always well visualized
- "v wave": Passive atrial filling against a slightly bulging atrioventricular valve during ventricular systole which leads to increased pressure throughout the TP interval
Negative Waves
- "x wave": Follows the "a" and "c" waves, atrial pressure drops after atrial systole
- "y wave": Passive right atrial emptying into the right ventricle when the tricuspid valve opens, just before atrial systole
Waveform Analysis
- Obtain graphic readouts with both ECG (electrical) and RAP (mechanical) tracings
- RAP: Ending inspiration eliminates intrathoracic pressure and inspiration leads to negative pressure breath, which cause downward reflection in RAP
- Ventilators with positive pressure increase inspiration, resulting in positive pressure
- Positive end-expiratory pressure above 10 cm H20 elevates the entire waveform above baseline
Physiological and Pathophysiological Conditions Affecting CVP, PA, SVR
- Accuracy requires reading waveforms at end-expiration when pleural pressure is at its lowest level and measurement should be done with simultaneous ECG tracing
CVP/RAP
- Measures right atrial pressure (RAP)
- Indicates R heart preload and fluid volume status.
CVP/RAP Increase
- Heart failure due to fluid overload, decreasing venous return
- Pericarditis because inflammation restricts heart function
- Fluid overload from excess IV fluids
- Tension pneumothorax increases thoracic pressure and compresses heart
- Increased blood volume causes high CVP and backup
- Pulmonary problems from high blood volume
CVP/RAP Decrease
- Hypovolemia from dehydration, hemorrhage, or severe burns results in low blood volume and low CVP
- Vasodilation from sepsis or anaphylaxis leads to decreased venous return
- Decreased blood volume causes a low CVP
PA
- Measures pulmonary artery pressure
PA Increase
- Pulmonary HTN increases resistance in pulmonary arteries
- Left heart failure causes blood to back up into the pulmonary circulation
- COPD increases resistance in the pulmonary vasculature
- Increased blood flow causes high PAP
PA Decrease
- Vasodilation from sepsis decreases PAP
- Decreased blood flow from low blood volume
SVR
- Represents resistance in the systemic arterial circulation reflects left ventricular afterload and help assess vascular tone and Cardiac output
- Evaluated for pulmonary HTN, heart failure and lung issues
SVR Increase
- Hypertension increases resistance
- Vasoconstriction may be caused by hypothermia or vasopressors
- Aortic stenosis
- SNS stimulation = high SVR
SVR Decrease
- Sepsis leads to widespread vasodilation
- Anaphylaxis
- Neurogenic shock
- PNS stimulation = low SVR
Hemodynamic Formulas
-
Cardiac output (CO) is the amount of blood pumped by the heart per minute, calculated as heart rate multiplied by stroke volume
-
Normal CO = 4-8 L/min
-
Mean arterial pressure (MAP) is an approximation of average pressure in the systemic circulation throughout the cardiac cycle using digital readout w/ an arterial line or automatic BP equipment
-
Normal MAP = 70 - 90 mm Hg
-
MAP = SBP + 2(DBP)/3 if direct arterial monitoring isn't available
-
Cuff pressure values may be inaccurate due to incorrect size, difference in hearing, instrument sensitivity, patient movement
Normal Ranges
- CVP normal range is 2-6 mm Hg mean pressure
- Normal cardiac index is 2.4-4.0 L/min/m²
Guidelines for Prevention of Intravascular Catheter-Related Bloodstream Infections
- Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters if CLABSI rate has not been substantially reduced
- Replace gauze dressings used on short-term CVC sites every 2 days.
- Replace transparent dressings on short-term CVC sites at least every 7 days
- Use split septum valve over a mechanical valve when needleless systems are used
- Minimize contamination risk by scrubbing access port with chlorhexidine, povidone iodine, an iodophor, or 70% alcohol, and accessing the port with sterile devices
- Avoid using the femoral vein and use a subclavian rather than a jugular site for central venous access Prepare clean skin with a > 0.5% chlorhexidine-based preparation and use maximal sterile barrier precautions for insertion of CVCs, PICCs, or guidewire exchange
- Replace administration sets continuously used no more frequently than at 96-hour intervals, but at least every 7 days
- Replace peripherally inserted catheters no more frequently than every 72-96 hours to reduce risk of infection
- Use a sutureless securement device
Central Line Catheter Care
- Assess the system by ensuring adequate appropriate fluid is pressurized to 300 mmHg, with no air bubbles present
- Level and zero on qshift level as needed and maintain sterile dressing
- Prevent CLABSI via hand hygiene and scrub access port/hub vigorously friction immediately prior to EACH USE w/ chlorhexidine, povidone iodine, 70% alcohol, etc.
- Use Full precautions (PPE) + Sterile during insertion
Central Line Catheter Removal
- Place patient supine and flat
- Perform hand hygiene
- Don clean gloves and mask
- Turn off all infusions
- Remove+ discard dressing + don sterile gloves
- Clean with alcohol or chlorhexidine + clip any sutures
- Remove catheter in slow, even motion, inspecting catheter for sutures to prevent air emboli, use valsalva's maneuver which also prevents fluctuating pressure
- If mechanically ventilated, inspiration leads to negative pressure that can embolize so remove catheter during expiration instead
- Apply pressure for 2-3 min for hemostasis + clean site w/ transparent dressing inspecting catheter for intactness
Arterial Line Catheter Removal
- Insertion sites can include radial (most common), brachial, femoral and dorsalis pedis
- Insert during Allen's test to ensure collateral flow
- Sterile insertion
- Keep wrist on armboard when inserted
Arterial Line Catheter Removal
- Removal includes an assesed coagulation status
- Hold pressure longer if anticoagulated
- Non sterile gloves, face shield, protective gown (PPE) should be worn
- Alarms should then be turned off
- Remove any dressings, arm boards and securing devices ensuring to clean around catheter
- Place sterile 4x4 over site and remove smoothly holding pressure for at least 5-10 min applying 1-2 finger widths proximal to insertion site while assessing distal circulation
- After hemostasis has occurred then apply pressure dressing
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Description
Explore the relationship between the arterial waveform and the cardiac cycle. Understand the anacrotic limb, dicrotic notch, and systolic/diastolic pressures. A key focus is understanding how changes in the waveform relate to different cardiovascular conditions.
