Hemodynamic Monitoring Flashcards

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:

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?

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:

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:

Hard and non-compliant Signup and view all the answers

Leveling the transducer to the phlebostatic axis corrects for:

Hydrostatic pressure within the monitoring pressure line Signup and view all the answers

Zeroing the transducer to air corrects for:

Atmospheric pressure Signup and view all the answers

If the transducer is above the level of the phlebostatic axis, the pressure reading would be:

Inaccurately low Signup and view all the answers

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?

Tubing disconnected, pressure bag deflated, inadequate flush solution Signup and view all the answers

The transducer on a hemodynamic monitoring system:

Converts blood pressure into an electrical signal. Signup and view all the answers

Choose the best answer that describes how the numeric value of the hemodynamic pressure is transferred to the bedside monitor.

Catheter, fluid sensation, transducer, electrical signal, cable, monitor, display Signup and view all the answers

Central venous pressure (CVP) is a measurement of:

the pressure in the vena cava as it enters the right atrium of the heart. Signup and view all the answers

What does CVP infer?

the volume of blood in the right ventricle. Signup and view all the answers

What is CVP an indirect reflection of?

the patient's fluid volume status. Signup and view all the answers

What are the indications for CVP?

The need for close monitoring for changes in the patient's fluid volume status, such as hypovolemia, hypervolemia, rapid fluid resuscitation, or risks for rapid fluid loss. Signup and view all the answers

Continuous monitoring of the arterial BP involves three key hemodynamic values: what are they?

systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP). Signup and view all the answers

What is systolic pressure created by?

blood volume flowing through the artery. Signup and view all the answers

What is systolic pressure influenced by?

the force of ventricular contraction and the tone of the arterial bed. Signup and view all the answers

During diastole, what is happening and what is the pressure caused by?

The heart is at rest, during 'ventricular filling'; the pressure in the arterial system is mostly the product of vascular tone. Signup and view all the answers

What is the normal value for CVP?

ranges from 2-6 mmHg Signup and view all the answers

What is the CVP a determinant of?

the preload of the right ventricle. Signup and view all the answers

What can CVP be used to assess?

a patient's overall circulating volume and fluid status. Signup and view all the answers

When might a patient's normal CVP be different?

if they are receiving CPAP, BiPAP, or mechanical ventilation. Signup and view all the answers

Which circulation system does blood flow through between the right ventricle and the left atrium?

the pulmonary circulation. Signup and view all the answers

Is the amount of blood flowing from the right ventricle to the left ventricle influenced by pulmonary pathophysiology (e.g. COPD, pulmonary hypertension, PE)?

True Signup and view all the answers

What does cardiac output refer to and what is it measured in?

the rate at which blood is pumped out of the heart into the systemic circulation, usually measured in litres/minute. Signup and view all the answers

CVP reflects what pressure?

right ventricular end-diastolic pressure and is an indicator of preload. Signup and view all the answers

What is afterload?

the resistance that must be overcome by the ventricle to contract and eject blood into the systemic circulation. Signup and view all the answers

What is diastolic blood pressure a good indication of?

the higher the DBP, the higher the arterial tone. Signup and view all the answers

What is the equation for pulse pressure, and what is the normal value?

Pulse pressure = SBP - DBP. A normal value is around 40. Signup and view all the answers

What does a narrow pulse pressure indicate?

that the arteries are constricted, resulting in increased afterload. Signup and view all the answers

What does a wide pulse pressure indicate?

that the arteries are dilated and have a decreased afterload. Signup and view all the answers

What is MAP and what is it a good indicator of?

Mean Arterial Pressure is a 'weighted average' of blood pressure during the entire cardiac cycle and is a good indicator of overall tissue perfusion. Signup and view all the answers

What is the transducer responsible for?

sensing the pressure as the blood flows past the tip of the catheter inserted into the artery or vein. Signup and view all the answers

How does the transducer create a digital readout?

The transducer contains a chip that converts the sensed pressure waveform (mechanical pressure) into a digital readout. Signup and view all the answers

Every type of monitored invasive hemodynamic pressure requires completion of the following procedures to ensure accuracy. These include:

leveling the transducer, zeroing the transducer, performing the square waveform test. Signup and view all the answers

What does leveling the transducer refer to?

the process of moving the transducer to align with the phlebostatic axis. Signup and view all the answers

What is the phlebostatic axis?

the physical reference point on the chest that approximates the level of the right atrium and is used for consistent transducer height placement. Signup and view all the answers

What is the phlebostatic axis used for in cardiovascular pressure monitoring?

it is considered the zero reference point for cardiovascular pressure monitoring because the right atrium has the lowest pressure in the cardiovascular system. Signup and view all the answers

What is the difference in reading between the non-invasive blood pressure and the arterial blood pressure?

NIBP is acceptably 10-15 mmHg lower than the arterial BP. Signup and view all the answers

Should non-invasive blood pressure and the arterial blood pressure be taken on the same arm?

NIBP should be taken from the same arm in which the arterial BP cannula is inserted. Signup and view all the answers

The most accurate position to place a patient when reading the CVP is:

Supine with the head of bed at 0° (up to 30°). Signup and view all the answers

When is the CVP most accurate?

when the patient is still because it limits artifact picked up by the transducer. Signup and view all the answers

How should you take a CVP reading when the patient cannot be supine with no elevation?

Obtain the CVP measurement in a position that the patient can tolerate, ensuring that subsequent measurements are taken in the same position. Signup and view all the answers

On a triple lumen, which lumen exits furthest away from the patient?

The proximal lumen exits the furthest up from the catheter. Signup and view all the answers

Which lumen would best monitor CVP?

The distal lumen, because it is closest to the right atrium. Signup and view all the answers

Invasive hemodynamic monitoring involves some risk to the patient. These risks include:

Increased potential for infection, potential for decreased tissue perfusion, potential for embolization due to thrombus formation, blood loss due to disconnection. Signup and view all the answers

The two most common risks associated with invasive central venous pressure monitoring are:

Air embolus, infection. Signup and view all the answers

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.