week 11 Haemodynamic Monitoring
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Questions and Answers

What is the normal range of CVP, representing the filling pressure of the right side of the heart?

0 to +8 mmHg

What is a potential complication of invasive intra-arterial pressure monitoring?

Arterial thrombosis

What is the site of CVP measurement?

Right atrium or superior vena cava

What is a potential complication of invasive intra-arterial pressure monitoring?

<p>Air embolism</p> Signup and view all the answers

What has been challenged in regards to CVP monitoring?

<p>The traditional belief that CVP reflects ventricular preload and predicts fluid responsiveness</p> Signup and view all the answers

What is the reference point for levelling the transducer?

<p>The phlebostatic axis (intersection of the fourth intercostal space and the mid-thoracic anterior–posterior diameter).</p> Signup and view all the answers

What is included in invasive haemodynamic monitoring?

<p>Systemic arterial pressure monitoring, central venous pressure (CVP) monitoring, pulmonary artery pressure monitoring, and cardiac output monitoring.</p> Signup and view all the answers

What is the significance of cardiac output monitoring in haemodynamic monitoring?

<p>It provides information on the heart's ability to pump blood effectively.</p> Signup and view all the answers

What is the primary purpose of haemodynamic accuracy in monitoring?

<p>Checking the dynamic response of the monitor to signals from the blood vessel</p> Signup and view all the answers

What is the name of the test used to check the accuracy of subsequent haemodynamic pressure values?

<p>Fast-Flush Square-Wave Testing</p> Signup and view all the answers

What are the other possible sites for haemodynamic monitoring?

<p>Brachial, femoral, dorsalis pedis, and axillary arteries</p> Signup and view all the answers

What is the benefit of haemodynamic monitoring in periods of fluid volume instability?

<p>Precise and continuous monitoring of fluid volume</p> Signup and view all the answers

What is the importance of interpreting CVP in association with other haemodynamic variables?

<p>To ensure accurate diagnosis and treatment, as CVP alone may not provide a complete picture of a patient's haemodynamic status.</p> Signup and view all the answers

What does a dominant a wave in CVP waveform indicate?

<p>Pulmonary hypertension, tricuspid stenosis, or pulmonary stenosis.</p> Signup and view all the answers

What is the significance of an absent x descent in CVP waveform?

<p>Atrial fibrillation.</p> Signup and view all the answers

What does a sharp y descent in CVP waveform indicate?

<p>Severe tricuspid regurgitation or constrictive pericarditis.</p> Signup and view all the answers

What is the significance of a prominent x and y descent in CVP waveform?

<p>Right ventricular infarction.</p> Signup and view all the answers

What does a cannon a wave in CVP waveform indicate?

<p>Complete heart block or ventricular tachycardia with atrio-ventricular dissociation.</p> Signup and view all the answers

What is the significance of a dominant v wave in CVP waveform?

<p>Tricuspid regurgitation.</p> Signup and view all the answers

What is the main function of Central Venous Pressure (CVP) in haemodynamic monitoring?

<p>CVP represents the driving force for filling the right atrium and ventricle.</p> Signup and view all the answers

What does an exaggerated x descent in CVP waveform indicate?

<p>Pericardial tamponade or constrictive pericarditis.</p> Signup and view all the answers

What does the 'a' wave in CVP waveform analysis represent?

<p>Atrial contraction</p> Signup and view all the answers

What is the primary use of CVP monitoring in diagnosing cardiovascular conditions?

<p>Diagnosis of right ventricular infarction, right heart failure, tamponade, tricuspid regurgitation or stenosis, complete heart block, constrictive pericarditis, and differential diagnosis of shock state.</p> Signup and view all the answers

What is one of the causes of raised CVP?

<p>Fluid overload</p> Signup and view all the answers

What is the significance of the 'x' wave in CVP waveform analysis?

<p>Atrial relaxation, with downward movement of the tricuspid valve during ventricular contraction</p> Signup and view all the answers

What is one of the conditions that can be diagnosed using CVP monitoring?

<p>Right ventricular failure</p> Signup and view all the answers

What is the significance of the 'v' wave in CVP waveform analysis?

<p>Passive filling of atrium (tricuspid valve still closed)</p> Signup and view all the answers

Study Notes

Haemodynamic Monitoring

  • Involves the measurement of pressure, flow, and oxygenation within the cardiovascular system
  • Can be divided into non-invasive and invasive methods

Non-Invasive Monitoring

  • Includes measurement of:
    • Heart rate, pulses, ECGs
    • Blood pressure, capillary refill
    • Respiratory rate, pulse oximetry
    • Urine output
    • Body temperature, skin temperature

Invasive Monitoring

  • Includes measurement of:
    • Systemic arterial pressure
    • Central venous pressure (CVP)
    • Pulmonary artery pressure
    • Cardiac output

Principles of Haemodynamic Monitoring

  • Zeroing and levelling the transducer system ensures accuracy of readings
  • Fast-Flush Square-Wave Testing allows for checking the accuracy of subsequent haemodynamic pressure values

Invasive Intra-Arterial Pressure Monitoring

  • Commonly placed in the radial artery, but can also be in the brachial, femoral, dorsalis pedis, and axillary arteries
  • Indicated when precise and continuous monitoring is required, especially in periods of fluid volume, cardiac output, and blood pressure instability
  • Complications include:
    • Infection
    • Arterial thrombosis
    • Distal ischemia
    • Air embolism
    • Accidental disconnection leading to rapid blood loss
    • Accidental drug administration through the arterial catheter

Central Venous Pressure (CVP) Monitoring

  • CVP is the pressure recorded from the right atrium or superior vena cava, representing the filling pressure of the right side of the heart (0 to +8 mmHg)
  • CVP represents the driving force for filling the right atrium and ventricle
  • CVP Waveform Analysis:
    • a = atrial contraction
    • c = closing and bulging of the tricuspid valve
    • x = atrial relaxation, with downward movement of the tricuspid valve during ventricular contraction
    • v = passive filling of atrium (tricuspid valve still closed)
    • y = ventricular filling with opening of the tricuspid valve

Uses of CVP Monitoring

  • Diagnosis of right ventricular infarction, right heart failure, tamponade, tricuspid regurgitation or stenosis, complete heart block, constrictive pericarditis, and differential diagnosis of shock state
  • Correct central line placement
  • Right ventricular failure
  • Tricuspid stenosis or regurgitation
  • Pericardial effusion or constrictive pericarditis

Causes of Raised CVP

  • Superior vena caval obstruction
  • Fluid overload
  • Hyperdynamic circulation
  • High PEEP settings

Limitations of CVP

  • CVP should not be used in isolation to assess fluid responsiveness, as it has a very poor relationship with blood volume and is a poor predictor of the hemodynamic response to a fluid challenge
  • Interpretation of CVP should be in association with information relating to other haemodynamic variables

Waveform Abnormalities

  • Dominant a wave: pulmonary hypertension, tricuspid stenosis, pulmonary stenosis
  • Cannon a wave: complete heart block, ventricular tachycardia with atrio-ventricular dissociation
  • Dominant v wave: tricuspid regurgitation
  • Absent x descent: atrial fibrillation
  • Exaggerated x descent: pericardial tamponade, constrictive pericarditis
  • Sharp y descent: severe tricuspid regurgitation, constrictive pericarditis
  • Slow y descent: tricuspid stenosis, atrial myxoma
  • Prominent x and y descent: right ventricular infarction

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Week 11 Haemodynamic Monitoring PDF

Description

This quiz covers the basics of haemodynamic monitoring, including the measurement of pressure, flow, and oxygenation in the cardiovascular system, as well as non-invasive and invasive methods.

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