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Questions and Answers
The transducer on a hemodynamic monitoring system is leveled to the patient's phlebostatic axis. The phlebostatic axis is located at the:
The transducer on a hemodynamic monitoring system is leveled to the patient's phlebostatic axis. The phlebostatic axis is located at the:
- 4th intercostal space, mid A-P (correct)
- 4th intercostal space mid-axillary
- Level of the right atrium (correct)
- Level of the left ventricle
Which site is the most common for an arterial line to be inserted?
Which site is the most common for an arterial line to be inserted?
- Radial artery (correct)
- Brachial artery
- Femoral artery
- Femoral vein
You are assessing your patient's arterial line and cannot obtain a waveform on the monitor. You would immediately do all of the following except:
You are assessing your patient's arterial line and cannot obtain a waveform on the monitor. You would immediately do all of the following except:
- Ask to have the art-line re-inserted (correct)
- Ensure the monitor is set to the appropriate scale
- Check all the stopcocks for correct positioning
- Assess the patient's airway, breathing and circulation
A hemodynamic monitoring system uses high pressure tubing. This tubing is:
A hemodynamic monitoring system uses high pressure tubing. This tubing is:
Leveling the transducer to the phlebostatic axis corrects for:
Leveling the transducer to the phlebostatic axis corrects for:
Zeroing the transducer to air corrects for:
Zeroing the transducer to air corrects for:
If the transducer is above the level of the phlebostatic axis, the pressure reading would be:
If the transducer is above the level of the phlebostatic axis, the pressure reading would be:
During your shift, you notice that there is blood backing up in the arterial line from the site. What would be some possible reasons for this?
During your shift, you notice that there is blood backing up in the arterial line from the site. What would be some possible reasons for this?
The transducer on a hemodynamic monitoring system:
The transducer on a hemodynamic monitoring system:
Choose the best answer that describes how the numeric value of the hemodynamic pressure is transferred to the bedside monitor.
Choose the best answer that describes how the numeric value of the hemodynamic pressure is transferred to the bedside monitor.
Central venous pressure (CVP) is a measurement of:
Central venous pressure (CVP) is a measurement of:
What does CVP infer?
What does CVP infer?
What is CVP an indirect reflection of?
What is CVP an indirect reflection of?
What are the indications for CVP?
What are the indications for CVP?
Continuous monitoring of the arterial BP involves three key hemodynamic values: what are they?
Continuous monitoring of the arterial BP involves three key hemodynamic values: what are they?
What is systolic pressure created by?
What is systolic pressure created by?
What is systolic pressure influenced by?
What is systolic pressure influenced by?
During diastole, what is happening and what is the pressure caused by?
During diastole, what is happening and what is the pressure caused by?
What is the normal value for CVP?
What is the normal value for CVP?
What is the CVP a determinant of?
What is the CVP a determinant of?
What can CVP be used to assess?
What can CVP be used to assess?
When might a patient's normal CVP be different?
When might a patient's normal CVP be different?
Which circulation system does blood flow through between the right ventricle and the left atrium?
Which circulation system does blood flow through between the right ventricle and the left atrium?
Is the amount of blood flowing from the right ventricle to the left ventricle influenced by pulmonary pathophysiology (e.g. COPD, pulmonary hypertension, PE)?
Is the amount of blood flowing from the right ventricle to the left ventricle influenced by pulmonary pathophysiology (e.g. COPD, pulmonary hypertension, PE)?
What does cardiac output refer to and what is it measured in?
What does cardiac output refer to and what is it measured in?
CVP reflects what pressure?
CVP reflects what pressure?
What is afterload?
What is afterload?
What is diastolic blood pressure a good indication of?
What is diastolic blood pressure a good indication of?
What is the equation for pulse pressure, and what is the normal value?
What is the equation for pulse pressure, and what is the normal value?
What does a narrow pulse pressure indicate?
What does a narrow pulse pressure indicate?
What does a wide pulse pressure indicate?
What does a wide pulse pressure indicate?
What is MAP and what is it a good indicator of?
What is MAP and what is it a good indicator of?
What is the transducer responsible for?
What is the transducer responsible for?
How does the transducer create a digital readout?
How does the transducer create a digital readout?
Every type of monitored invasive hemodynamic pressure requires completion of the following procedures to ensure accuracy. These include:
Every type of monitored invasive hemodynamic pressure requires completion of the following procedures to ensure accuracy. These include:
What does leveling the transducer refer to?
What does leveling the transducer refer to?
What is the phlebostatic axis?
What is the phlebostatic axis?
What is the phlebostatic axis used for in cardiovascular pressure monitoring?
What is the phlebostatic axis used for in cardiovascular pressure monitoring?
What is the difference in reading between the non-invasive blood pressure and the arterial blood pressure?
What is the difference in reading between the non-invasive blood pressure and the arterial blood pressure?
Should non-invasive blood pressure and the arterial blood pressure be taken on the same arm?
Should non-invasive blood pressure and the arterial blood pressure be taken on the same arm?
The most accurate position to place a patient when reading the CVP is:
The most accurate position to place a patient when reading the CVP is:
When is the CVP most accurate?
When is the CVP most accurate?
How should you take a CVP reading when the patient cannot be supine with no elevation?
How should you take a CVP reading when the patient cannot be supine with no elevation?
On a triple lumen, which lumen exits furthest away from the patient?
On a triple lumen, which lumen exits furthest away from the patient?
Which lumen would best monitor CVP?
Which lumen would best monitor CVP?
Invasive hemodynamic monitoring involves some risk to the patient. These risks include:
Invasive hemodynamic monitoring involves some risk to the patient. These risks include:
The two most common risks associated with invasive central venous pressure monitoring are:
The two most common risks associated with invasive central venous pressure monitoring are:
Study Notes
Hemodynamic Monitoring Overview
- Transducer is leveled to the phlebostatic axis, located at the level of the right atrium or the 4th intercostal space, mid A-P.
- Most common site for arterial line insertion is the radial artery.
Assessing Arterial Line Function
- If no waveform is obtained on the monitor, check stopcocks, patient circulation, and monitor settings, but do not immediately request re-insertion of the art-line.
- High pressure tubing is necessary for accurate readings and is hard and non-compliant.
Importance of Leveling and Zeroing
- Leveling the transducer corrects for hydrostatic pressure in the monitoring line.
- Zeroing the transducer to air corrects for atmospheric pressure.
Pressure Readings and Implications
- A transducer positioned above the phlebostatic axis yields inaccurately low pressure readings.
- Blood backing up in the arterial line may indicate disconnected tubing, a deflated pressure bag, or insufficient flush solution.
Function and Measurement Principles
- The transducer converts blood pressure into an electrical signal and is crucial for accurate monitoring systems.
- Central venous pressure (CVP) measures pressure in the vena cava as it enters the right atrium and reflects fluid volume status.
Indications and Applications of CVP
- Indicated for monitoring fluid volume status during conditions such as hypovolemia or rapid fluid resuscitation.
- Normal CVP ranges from 2-6 mmHg, reflecting right ventricular preload.
Cardiac Output and Hemodynamic Values
- Cardiac output is the rate of blood pumped from the heart, measured in liters per minute.
- Continuous arterial blood pressure monitoring includes systolic pressure (SBP), diastolic pressure (DBP), and mean arterial pressure (MAP).
Blood Pressure Dynamics
- Systolic pressure is influenced by blood volume and ventricular contraction force.
- Diastolic pressure indicates vascular tone; higher DBP suggests higher arterial tone.
- Pulse pressure is calculated as SBP - DBP, with a normal value around 40.
Effects of Pulse Pressure Variance
- Narrow pulse pressure indicates increased afterload due to vascular constriction, often seen in heart failure.
- Wide pulse pressure suggests decreased afterload due to vascular dilation, common in sepsis.
Understanding MAP
- Mean Arterial Pressure (MAP) represents overall tissue perfusion and is a "weighted average" during the cardiac cycle.
- Transducer accuracy depends on proper leveling and zeroing procedures.
Positioning for Accurate CVP Measurement
- CVP is most accurately measured in a supine position with the head of the bed at 0° to 30°.
- Movement or elevation can introduce artifacts, impacting reading accuracy.
Monitoring Equipment and Techniques
- The distal lumen of a triple lumen catheter is best for CVP monitoring, being closest to the right atrium.
- Risks associated with invasive monitoring include infection, air embolus, potential tissue perfusion issues, and blood loss from disconnections.
Summary of Risks
- Increased infection risk at the insertion site.
- Risk of embolization due to thrombus formation at the catheter tip.
- Possibility of decreased tissue perfusion due to catheter displacement or clot formation.
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Description
Test your knowledge on key terms and concepts related to hemodynamic monitoring with these flashcards. Learn about the phlebostatic axis and common arterial line insertion sites to enhance your understanding of this critical nursing skill.
