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A patient's heart rate is 80 beats per minute and their stroke volume is 70 mL/beat. What calculation determines their cardiac output in liters per minute?
A patient's heart rate is 80 beats per minute and their stroke volume is 70 mL/beat. What calculation determines their cardiac output in liters per minute?
- $CO = (80 \times 70) / 1000$ (correct)
- $CO = (80 + 70) \times 1000$
- $CO = (80 \times 70) \times 1000$
- $CO = (80 + 70) / 1000$
A patient has a blood pressure of 130/80 mm Hg. What is the mean arterial pressure (MAP)?
A patient has a blood pressure of 130/80 mm Hg. What is the mean arterial pressure (MAP)?
- 80 mm Hg
- 97 mm Hg (correct)
- 90 mm Hg
- 100 mm Hg
A patient with a CVP of 9 mm Hg might indicate which of the following conditions?
A patient with a CVP of 9 mm Hg might indicate which of the following conditions?
- Vasodilation
- Fluid Overload (correct)
- Dehydration
- Hypotension
Which set of vital signs is within normal limits?
Which set of vital signs is within normal limits?
A patient's cardiac output is 3.5 L/min. If their body surface area is 1.75 m^2, what is their cardiac index?
A patient's cardiac output is 3.5 L/min. If their body surface area is 1.75 m^2, what is their cardiac index?
Which of the following MAP values would be most concerning, potentially indicating inadequate tissue perfusion?
Which of the following MAP values would be most concerning, potentially indicating inadequate tissue perfusion?
During central line removal, what is the primary rationale for placing the patient in a supine position?
During central line removal, what is the primary rationale for placing the patient in a supine position?
What is the correct order of steps when discontinuing an arterial line?
What is the correct order of steps when discontinuing an arterial line?
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?
The dicrotic notch in the arterial waveform signifies which event in the cardiac cycle?
The dicrotic notch in the arterial waveform signifies which event in the cardiac cycle?
Which component of the arterial waveform represents the point of maximum systolic pressure?
Which component of the arterial waveform represents the point of maximum systolic pressure?
What is the primary event occurring during the dicrotic limb of the arterial waveform?
What is the primary event occurring during the dicrotic limb of the arterial waveform?
The lowest point of the arterial waveform corresponds to what?
The lowest point of the arterial waveform corresponds to what?
Which of the following represents the correct range for a typical diastolic pressure?
Which of the following represents the correct range for a typical diastolic pressure?
During ventricular systole, which of the following events does NOT occur?
During ventricular systole, which of the following events does NOT occur?
If a patient's arterial waveform shows an absent dicrotic notch, what might this indicate?
If a patient's arterial waveform shows an absent dicrotic notch, what might this indicate?
A patient has a blood pressure reading of 150/90 mmHg. Which component(s) of the arterial waveform are directly represented by these numbers?
A patient has a blood pressure reading of 150/90 mmHg. Which component(s) of the arterial waveform are directly represented by these numbers?
Which valve closure is directly responsible for the dicrotic notch observed on the arterial waveform?
Which valve closure is directly responsible for the dicrotic notch observed on the arterial waveform?
Which of the following actions is MOST critical in preventing a Central Line-Associated Bloodstream Infection (CLABSI) during central line catheter care?
Which of the following actions is MOST critical in preventing a Central Line-Associated Bloodstream Infection (CLABSI) during central line catheter care?
When removing a central line catheter, why is it essential to wear sterile gloves?
When removing a central line catheter, why is it essential to wear sterile gloves?
What is the primary focus when assessing a central line system?
What is the primary focus when assessing a central line system?
After removing an arterial line, what is the MOST important immediate nursing intervention?
After removing an arterial line, what is the MOST important immediate nursing intervention?
Which action is LEAST likely to cause an arterial line to be inaccurate?
Which action is LEAST likely to cause an arterial line to be inaccurate?
When discontinuing a central line, what instruction should the nurse provide to the patient during the removal process?
When discontinuing a central line, what instruction should the nurse provide to the patient during the removal process?
A patient with an arterial line suddenly develops a hematoma at the insertion site. What is the nurse's FIRST action?
A patient with an arterial line suddenly develops a hematoma at the insertion site. What is the nurse's FIRST action?
What is the primary reason for maintaining a closed system when caring for a central line catheter?
What is the primary reason for maintaining a closed system when caring for a central line catheter?
The 'a' wave on a right atrial pressure waveform corresponds to which mechanical event in the cardiac cycle?
The 'a' wave on a right atrial pressure waveform corresponds to which mechanical event in the cardiac cycle?
What does the 'v' wave in the CVP/RAP waveform represent?
What does the 'v' wave in the CVP/RAP waveform represent?
The 'c' wave on the right atrial waveform is associated with which event?
The 'c' wave on the right atrial waveform is associated with which event?
What physiological process does the 'y' descent on the right atrial pressure waveform indicate?
What physiological process does the 'y' descent on the right atrial pressure waveform indicate?
What is represented by the 'x' descent on a right atrial pressure waveform?
What is represented by the 'x' descent on a right atrial pressure waveform?
When measuring waveforms for accuracy, at which point in the respiratory cycle should measurements be taken?
When measuring waveforms for accuracy, at which point in the respiratory cycle should measurements be taken?
To accurately measure CVP waveforms, which of the following is required?
To accurately measure CVP waveforms, which of the following is required?
What is the significance of analyzing both ECG and RAP tracings together?
What is the significance of analyzing both ECG and RAP tracings together?
During which phase of the cardiac cycle does passive filling of the ventricles primarily occur?
During which phase of the cardiac cycle does passive filling of the ventricles primarily occur?
Which of the following conditions might lead to an increase in CVP?
Which of the following conditions might lead to an increase in CVP?
The CVP waveform component 'a' corresponds with the ECG component?
The CVP waveform component 'a' corresponds with the ECG component?
If a patient has a fever, how might this impact their CVP, assuming other factors remain constant?
If a patient has a fever, how might this impact their CVP, assuming other factors remain constant?
During diastole, which valves are open to allow passive filling of the ventricles?
During diastole, which valves are open to allow passive filling of the ventricles?
A patient presents with jugular venous distension, peripheral edema, and a rapid weight gain. Based on these findings, which of the following conditions is MOST likely to cause an increase in the patient's CVP/RAP?
A patient presents with jugular venous distension, peripheral edema, and a rapid weight gain. Based on these findings, which of the following conditions is MOST likely to cause an increase in the patient's CVP/RAP?
A patient's CVP/RAP reading is significantly lower than normal. Which of the following conditions should the nurse suspect?
A patient's CVP/RAP reading is significantly lower than normal. Which of the following conditions should the nurse suspect?
A patient with pericarditis is being monitored for changes in hemodynamic parameters. What effect can pericarditis have on CVP/RAP?
A patient with pericarditis is being monitored for changes in hemodynamic parameters. What effect can pericarditis have on CVP/RAP?
A patient with a tension pneumothorax is showing signs of hemodynamic instability. How does tension pneumothorax typically affect CVP/RAP?
A patient with a tension pneumothorax is showing signs of hemodynamic instability. How does tension pneumothorax typically affect CVP/RAP?
A patient diagnosed with pulmonary hypertension is being monitored. What is the expected effect of pulmonary hypertension on pulmonary artery pressure (PAP)?
A patient diagnosed with pulmonary hypertension is being monitored. What is the expected effect of pulmonary hypertension on pulmonary artery pressure (PAP)?
A patient with left-sided heart failure is being evaluated for hemodynamic changes. What would be the expected effect on the pulmonary artery pressure (PAP)?
A patient with left-sided heart failure is being evaluated for hemodynamic changes. What would be the expected effect on the pulmonary artery pressure (PAP)?
A patient with severe COPD is assessed for pulmonary artery pressure (PAP). How does COPD affect PAP?
A patient with severe COPD is assessed for pulmonary artery pressure (PAP). How does COPD affect PAP?
A patient in septic shock is showing signs of vasodilation. How does this condition typically affect pulmonary artery pressure (PAP)?
A patient in septic shock is showing signs of vasodilation. How does this condition typically affect pulmonary artery pressure (PAP)?
A patient is diagnosed with aortic stenosis. How does this condition affect systemic vascular resistance (SVR)?
A patient is diagnosed with aortic stenosis. How does this condition affect systemic vascular resistance (SVR)?
A patient is experiencing neurogenic shock. How does this condition affect systemic vascular resistance (SVR)?
A patient is experiencing neurogenic shock. How does this condition affect systemic vascular resistance (SVR)?
A patient who is hypothermic is being monitored. What effect does hypothermia have on systemic vascular resistance (SVR)?
A patient who is hypothermic is being monitored. What effect does hypothermia have on systemic vascular resistance (SVR)?
A patient is in anaphylactic shock. How does anaphylaxis affect systemic vascular resistance (SVR)?
A patient is in anaphylactic shock. How does anaphylaxis affect systemic vascular resistance (SVR)?
A patient presents with a CVP of 18 mmHg. Which of the following conditions is MOST likely contributing to this finding?
A patient presents with a CVP of 18 mmHg. Which of the following conditions is MOST likely contributing to this finding?
A patient has a pulmonary artery pressure (PAP) reading that is significantly elevated. This finding is MOST consistent with which of the following conditions?
A patient has a pulmonary artery pressure (PAP) reading that is significantly elevated. This finding is MOST consistent with which of the following conditions?
A patient has a systemic vascular resistance (SVR) reading that is significantly below normal. Which of the following conditions is MOST likely contributing to this finding?
A patient has a systemic vascular resistance (SVR) reading that is significantly below normal. Which of the following conditions is MOST likely contributing to this finding?
Flashcards
Anacrotic Limb
Anacrotic Limb
The initial steep rise in the arterial waveform, indicating blood ejection 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 descending portion of the arterial waveform after the systolic peak, showing reduced force of blood ejection.
Dicrotic Notch
Dicrotic Notch
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Diastolic Pressure
Diastolic Pressure
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Systole
Systole
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Normal Systolic Pressure
Normal Systolic Pressure
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Normal Diastolic Pressure
Normal Diastolic Pressure
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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
"A" Wave
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"C" Wave
"C" Wave
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"V" Wave
"V" Wave
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"X" Descent
"X" Descent
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"Y" Descent
"Y" Descent
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Waveform Analysis (ECG & RAP)
Waveform Analysis (ECG & RAP)
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CVP "a" Wave Timing
CVP "a" Wave Timing
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CVP/PCWP "c" Wave Timing
CVP/PCWP "c" Wave Timing
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CVP "v" Wave Timing
CVP "v" Wave Timing
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End-Expiration
End-Expiration
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Analog Tracing with ECG
Analog Tracing with ECG
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ECG
ECG
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RAP (Right Atrial Pressure)
RAP (Right Atrial Pressure)
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Central Line System Assessment
Central Line System Assessment
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CLABSI Prevention
CLABSI Prevention
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Central Line Removal Process
Central Line Removal Process
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Central Line Removal Gloves
Central Line Removal Gloves
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Arterial Line Insertion Sites
Arterial Line Insertion Sites
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Arterial Line Insertion
Arterial Line Insertion
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Arterial Line Removal
Arterial Line Removal
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Post Arterial Line Removal
Post Arterial Line Removal
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Cardiac Output (CO)
Cardiac Output (CO)
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Mean Arterial Pressure (MAP)
Mean Arterial Pressure (MAP)
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Central Venous Pressure (CVP)
Central Venous Pressure (CVP)
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Cardiac Index (CI)
Cardiac Index (CI)
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Stroke Volume (SV)
Stroke Volume (SV)
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Heart Rate (HR)
Heart Rate (HR)
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Systolic Blood Pressure (SBP)
Systolic Blood Pressure (SBP)
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Diastolic Blood Pressure (DBP)
Diastolic Blood Pressure (DBP)
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CVP/RAP
CVP/RAP
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Causes of increased CVP/RAP
Causes of increased CVP/RAP
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Causes of decreased CVP/RAP
Causes of decreased CVP/RAP
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PA (Pulmonary Artery Pressure)
PA (Pulmonary Artery Pressure)
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Causes of increased PA pressure
Causes of increased PA pressure
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Causes of decreased PA pressure
Causes of decreased PA pressure
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SVR (Systemic Vascular Resistance)
SVR (Systemic Vascular Resistance)
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Causes of increased SVR
Causes of increased SVR
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Causes of decreased SVR
Causes of decreased SVR
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How does hypertension relate to SVR?
How does hypertension relate to SVR?
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How does sepsis affect SVR?
How does sepsis affect SVR?
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How does aortic stenosis affect SVR?
How does aortic stenosis affect SVR?
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How does neurogenic shock affect SVR?
How does neurogenic shock affect SVR?
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Parasympathetic nervous system (PNS)
Parasympathetic nervous system (PNS)
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Sympathetic nervous system (SNS)
Sympathetic nervous system (SNS)
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Study Notes
- Arterial and atrial waveforms are components of the cardiac cycle (systole and diastole).
Arterial Waveform
- Anacrotic limb: Occurs when the aortic valve opens, leading to blood flow into the aorta; steep upstroke.
- Top of limb: Corresponds to the peak/highest systolic pressure, typically ranging from 100-140.
- Dicrotic limb: Systolic ejection of blood continues but at a reduced force; the waveform descends.
- Dicrotic notch: Represents the closure of the aortic valve, marking the beginning of ventricular diastole, disrupts the dicrotic limb.
- Baseline: Indicates diastolic pressure, usually between 60-80; it's the lowest portion of the 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
- Characteristic undulating pattern consisting of 3 positive and 2 negative excursions.
- Undulations represent mechanical events in the cardiac cycle.
- a wave: Atrial contraction; increases atrial pressure, occuring during the PR interval on an ECG.
- c wave: Closure of the tricuspid valve in early systole; coincides with the end of the QRS complex on an ECG, not always well visualized.
- v wave: Passive atrial filling against a slightly bulging atrioventricular valve during ventricular systole; increased pressure, correlated with the the TP interval on an ECG.
- x descent: Follows the a and c waves; drop in atrial pressure after atrial systole.
- y descent: Passive right atrial emptying into the right ventricle when the tricuspid valve opens, just prior to atrial systole.
Waveform Analysis
- Requires a graphic readout with both ECG and RAP tracings.
- ECG: Electrical activity.
- RAP: Mechanical activity (end-inspiration to eliminate intrathoracic pressure).
- Inspiration causes a negative pressure breath (downward reflection in RAP).
- Ventilator with positive pressure: inspiration leads to a positive result.
- Positive end-expiratory pressure above 10 cm H20 elevates the entire waveform above baseline.
Measuring Waveforms
- Accuracy requires reading waveforms at end-expiration when pleural pressure is at its lowest level.
- Measurement should be done from an analog tracing that includes simultaneous ECG tracing.
Central Venous Pressure (CVP/RAP)
- Measures right atrial pressure (RAP) reflecting R heart preload & fluid volume status.
- Increased CVP/RAP: HF (fluid overload, decrease venous return), Pericarditis, Fluid overload (Excess IV fluids), Tension pneumothorax, Increased BV, Pulmonary problems.
- Decreased CVP/RAP: Hypovolemia, Vasodilation, Decreased BV.
Pulmonary Artery Pressure (PA)
- Measures pulmonary artery pressure.
- Increased PA: Pulmonary HTN (increase resistance), Left HF, COPD and Increased blood flow.
- Decreased PA: Hypovolemia and Vasodilation.
Systemic Vascular Resistance (SVR)
- Represents resistance in systemic arterial circulation.
- Reflects left ventricular afterload and assesses vascular tone and CO (Shock, vasodilation).
- Increased SVR: HTN, Vasoconstriction, Aortic stenosis, SNS stimulation. Decreased SVR: Sepsis, Anaphylaxis, Neurogenic shock, PNS stimulation.
Formulas
- Cardiac output (CO): Amount of blood pumped by the heart per minute; calculated as CO = HR x SV. Normal range is 4-8 L/min.
- Mean Arterial pressure (MAP): Approximation of average pressure in the systemic circulation throughout the cardiac cycle. Normal: 70 - 90 mm Hg.
- MAP Calculation: MAP = SBP + 2(DBP)/3; must be calculated if direct arterial monitoring isn't available, cuff pressure values may be inaccurate.
Normal Ranges
- CVP: Normal range is 2-6 mm Hg.
- Cardiac Index: Normal range is 2.4-4.0 L/min/m².
- MAP: 70 - 90 mm Hg.
Central Line Catheter Care and Maintenance
- Assess system:
- Sterile dressing
- Adequate appropriate fluid
- Pressurized to 300 mm Hg
- Ensure no air bubbles or dampening effect
- Level and zero Q shift, as needed.
- Prevent CLABSI by ensuring hand hygiene and scrubbing access port/hub vigorously prior to each use with chlorhexidine, povidone-iodine, or 70% alcohol; full precautions and sterile technique during insertion.
Central Line Catheter Removal
- Place patient supine and flat.
- Hand hygiene, clean gloves, mask.
- Turn off all infusions.
- Remove and discard dressing.
- Use sterile gloves and clean with alcohol or chlorhexidine.
- Clip sutures, (if present).
- Remove catheter in slow, even motion and inspect catheter for sutures.
- Have patient perform Valsalva's maneuver (hold breath, bear down) to prevent air emboli.
- If mechanically ventilated, remove during expiration instead.
- Apply pressure for 2-3 min for hemostasis.
- Clean site with a transparent dressing and inspect catheter for intactness.
Arterial Line Catheter Removal
- Insertion sites include radial (most common), brachial, femoral, and dorsalis pedis.
- Insertion procedure:
- Perform Allen's test ensuring radial and ulnar artery patency.
- Use a 20g angiocath and sterile technique.
- Use biopatch and transparent dressing; secure the wrist with an armboard.
- Removal procedure:
- Assess coagulation status.
- If anticoagulated/low platelets, hold pressure longer.
- Wear nonsterile gloves, face shield, and protective gown.
- Turn off alarms.
- Remove any dressings, arm boards, securing devices, etc.
- Clean around catheter.
- Place sterile 4x4 over site and remove smoothly.
- Hold pressure for at least 5-10 min (1-2 finger widths proximal to insertion site).
- Assess distal circulation and apply pressure dressing after hemostasis has occurred.
Guidelines for the Prevention of Intravascular Catheter-Related Bloodstream Infections
- Use a chlorhexidine-impregnated sponge dressing for temporary short-term catheters in patients older than 2 months if the CLABSI rate has not been substantially reduced.
- Replace gauze dressings used on short-term CVC sites every 2 days. Category II
- Replace transparent dressings used on short-term CVC sites at least every 7 days, except in pediatric patients in whom the risk of dislodging the catheter may outweigh the benefit of changing the dressing.
- Use of needleless systems a split septum valve may be preferred over a mechanical valve.
- Minimize contamination risk by scrubbing the access port with an appropriate antiseptic and accessing the port only with sterile devices.
- Avoid using the femoral vein for central venous access in adult patients. Category IA
- Use a subclavian rather than a jugular site in adult patients to minimize infection risk for nontunneled CVC placement.
- Prepare clean skin with a > 0.5% chlorhexidine-based preparation before central venous catheter insertion and during dressing changes. If there is a contraindication to chlorhexidine, alternatives include tincture of iodine, an iodophor, or 70% alcohol.
- Use maximal sterile barrier precautions including the use of a cap, mask, sterile gown, sterile gloves, and a sterile full-body drape for insertion of CVCs, PICCs, or guidewire exchange.
- In patients not receiving blood, blood products, or lipid fat emulsions, replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, but at least every 7 days.
- Replace peripheral catheters no more frequently than every 72-96 hours to reduce risk of infection and phlebitis in adults.
- Use a sutureless securement device to reduce the risk of infection for intravascular catheters.
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Description
Understand key hemodynamic concepts with calculations of cardiac output, mean arterial pressure (MAP), and cardiac index. Identify normal vital signs and interpret central venous pressure (CVP) values. Review the steps for safe arterial and central line management.
