Cardiovascular Pressure & Output Measurements

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary use of central venous pressure monitoring?

To measure cardiac output

To monitor pulmonary artery pressure

To monitor central venous oxygen saturation

To administer caustic drugs and total parenteral nutrition (correct)

What is a contraindication for central venous catheterization?

Air emboli

Hypovolemia and shock

Tumors in the cannulation site (correct)

Poor peripheral veins

What is the normal range for central venous oxygen saturation?

>65% (correct)

>70%

>50%

>80%

What is the primary complication of central venous catheterization?

Infection Signup and view all the answers

What is the purpose of floating a Swan?

To place a pulmonary artery catheter Signup and view all the answers

What is the indication for using a central venous catheter in patients with poor peripheral veins?

To gain venous access Signup and view all the answers

What is the significance of a low central venous oxygen saturation?

Inadequate oxygen delivery to tissues Signup and view all the answers

What is an elevated central venous oxygen saturation indicative of?

Arterial-venous shunting or impaired cellular oxygen utilization Signup and view all the answers

What is the recommended angle to the skin when advancing the needle during internal jugular vein cannulation?

30o Signup and view all the answers

Why is it recommended to use bactericidal skin prep with alcohol-based solutions during internal jugular vein cannulation?

To reduce the risk of infection Signup and view all the answers

What is the purpose of aspirating continuously while advancing the needle during internal jugular vein cannulation?

To confirm the needle's location in a vein Signup and view all the answers

What is the recommended method to confirm venous vs arterial pressure during internal jugular vein cannulation?

By transducing free blood flow using IV extension tubing Signup and view all the answers

What is the purpose of flushing each of the ports to remove air during internal jugular vein cannulation?

To remove air from the catheter before placement Signup and view all the answers

What is the recommended landmark to locate the internal jugular vein during cannulation?

The lateral head of the sternocleidomastoid muscle and the nipple Signup and view all the answers

What is the purpose of using sterile gloves, gown, mask, and hair cover during internal jugular vein cannulation?

To minimize the risk of infection Signup and view all the answers

Why is real-time ultrasound guidance recommended during internal jugular vein cannulation?

To aid in anatomic identification Signup and view all the answers

What is the primary purpose of leaving the most distal port open during catheter placement?

To enable the guidewire to pass through the catheter Signup and view all the answers

What is a potential complication of central venous cannulation?

Pneumothorax Signup and view all the answers

What is the approximate right atrial pressure reflected by central venous pressure (CVP)?

5-10 mmHg Signup and view all the answers

What is the purpose of placing a finger or thumb over the connection point on the catheter during guidewire removal?

To prevent air embolism Signup and view all the answers

What is a characteristic of non-compliant ventricles?

They have large swings in pressure with minimal volume changes Signup and view all the answers

What is the typical range of normal CVP values in cm H2O?

5-10 cm H2O Signup and view all the answers

What is the purpose of securing the connection of the appropriate monitoring tubing or infusion tubing?

To prevent kinking or disconnection Signup and view all the answers

What is the significance of the 'a' wave in the CVP waveform?

It corresponds to atrial contraction Signup and view all the answers

Study Notes

Central Venous Catheterization

Indications: Monitoring central venous pressure (CVP), fluid administration to treat hypovolemia and shock, infusion of caustic drugs and total parenteral nutrition (TPN), aspiration of air emboli, insertion of transcutaneous pacing leads, and gaining venous access in patients with poor peripheral veins
Contraindications: Tumors, clots, or tricuspid valve vegetations that could be dislodged or embolized during cannulation, and site-specific contraindications

Technique of Central Venous Catheterization

Prepare the site with hand scrub, sterile gloves, gown, mask, hair cover, bactericidal skin prep, and sterile drapes
Locate the internal jugular vein using landmarks or real-time ultrasound guidance
Advance a needle along the medial border of the lateral head of the sternocleidomastoid toward the ipsilateral nipple, and an angle of 30o to the skin while pointing just lateral to the carotid artery pulse
Aspirate continuously to obtain venous blood and confirm the needle's location in a vein
Use a secondary needle or a syringe with needle to advance the guide wire through the syringe without the need for both a locator needle and placement needle
Transduce free blood flow to confirm venous vs arterial pressure using IV extension tubing or tubing included in the access kit
Prepare the catheter for placement by flushing each of the ports to remove air using saline or LR

Risks of Cannulation

Line infection
Bloodstream infection
Air or thrombus embolism
Arrhythmias indicating the catheter tip is in the right atrium or ventricle
Hematoma
Pneumothorax
Hemothorax
Hydrothorax
Chylothorax
Cardiac perforation
Cardiac tamponade
Trauma to nearby nerves and arteries
Thrombosis

Clinical Considerations of Central Venous Pressure (CVP)

CVP approximates right atrial pressure
Ventricular volumes are related to pressures through compliance, with highly compliant ventricles able to accommodate volume with minimal changes in pressure
Noncompliant ventricles have larger swings in pressure with less volume change
A very low CVP may indicate a volume-depleted patient, but moderate to high pressure readings may reflect volume overload, poor ventricular compliance, or both
Using CVP in conjunction with other measures of hemodynamic performance may be a better indicator of a patient's volume responsiveness

CVP Waveform

The shape of the waveform corresponds to the events of cardiac contraction
The waveform consists of five different waves:
- a waves are from atrial contraction
- Other waves will be described individually

Pulmonary Artery Catheterization

Introduce pulmonary artery (PA) catheters and discuss risks and benefits of their use
Discuss pulmonary artery catheter placement, and how to "Float a Swan"

Cardiac Output Measurements

Introduce and discuss various techniques for monitoring and calculating cardiac output
Discuss echocardiography and the TEE probe with common views

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

Learn about central venous pressure, pulmonary artery pressure, and cardiac output measurements, including risks and benefits of cannulization and catheter placement.