Hemodynamic Study Guide PDF

Identify the components of the arterial and atrial waveforms and the phase of the cardiac cycle (systole & diastole) (ch 7) --------------------------------------------------------------------------------------------------------------------------- +-----------------------------------+--------------...

Identify the components of the arterial and atrial waveforms and the phase of the cardiac cycle (systole & diastole) (ch 7) --------------------------------------------------------------------------------------------------------------------------- +-----------------------------------+-----------------------------------+ | Arterial Waveform | Components | | | | | | +--------------+--------------+ | | | | Anacrotic | When aortic | | | | | limb | valve opens, | | | | | | blood → | | | | | | aorta | | | | | | | | | | | | Steep | | | | | | upstroke= | | | | | | | | | | | | Top of limb | | | | | | = | | | | | | peak/highest | | | | | | **systolic | | | | | | pressure | | | | | | (100-140)** | | | | +==============+==============+ | | | | Dicrotic | Systolic | | | | | limb | ejection of | | | | | | blood that's | | | | | | continuing | | | | | | at a reduced | | | | | | force | | | | | | | | | | | | Waveform | | | | | | descends | | | | +--------------+--------------+ | | | | Dicrotic | Closure of | | | | | notch | the aortic | | | | | | valve, | | | | | | beginning of | | | | | | ventricular | | | | | | diastole | | | | | | | | | | | | Disrupts the | | | | | | dicrotic | | | | | | limb | | | | +--------------+--------------+ | | | | Baseline | **Diastolic | | | | | | pressure | | | | | | (60-80)** | | | | | | | | | | | | Lowest | | | | | | portion of | | | | | | the waveform | | | | +--------------+--------------+ | | | | | | Systole Includes atrial rela | | | xation, ventricular contraction, | | | tricuspid and mitral valve closur | | | e, and ejection of blood from ven | | | tricles. | | | ---------- -------------------- | | | --------------------------------- | | | --------------------------------- | | | --------------------------------- | | | ----------- | | | Diastole Involves atrial cont | | | raction, ventricular relaxation, | | | and passive filling of ventricles | | | through open tricuspid and mitra | | | l valves. | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | Right atrial waveform | Characteristic undulating pattern | | | consisting of 3 positive + 2 | | CVP/RAP Waveform | negative excursions | | | | | | Undulations = mechanical events | | | in cardiac cycle | | |  | | | | | | Positive (apple cider vinegar) | | | | | | +--------------+--------------+ | | | | A | **Atrial | | | | | | systole/cont | | | | | | raction | | | | | | (kick)** → | | | | | | increase in | | | | | | atrial | | | | | | pressure | | | | | | | | | | | | PR interval | | | | +==============+==============+ | | | | C | **Closure of | | | | | | tricuspid | | | | | | valve** in | | | | | | early | | | | | | systole | | | | | | | | | | | | Not always | | | | | | well | | | | | | visualized | | | | | | | | | | | | End of QRS | | | | +--------------+--------------+ | | | | V | **Passive | | | | | | atrial | | | | | | filling** | | | | | | against a | | | | | | slightly | | | | | | bulging | | | | | | atrioventric | | | | | | ular | | | | | | valve during | | | | | | ventricular | | | | | | systole → | | | | | | increased | | | | | | pressure | | | | | | | | | | | | TP interval | | | | +--------------+--------------+ | | | | | | Negative (xy) | | | | | | +--------------+--------------+ | | | | X | Follows a & | | | | | | c | | | | | | | | | | | | Drop in | | | | | | atrial | | | | | | pressure | | | | | | after atrial | | | | | | systole | | | | +==============+==============+ | | | | Y | **Passive | | | | | | right atrial | | | | | | emptying | | | | | | into the | | | | | | right | | | | | | ventricle** | | | | | | when the | | | | | | tricuspid | | | | | | valve opens, | | | | | | just prior | | | | | | to atrial | | | | | | systole | | | | +--------------+--------------+ | +===================================+===================================+ | Waveform analysis | Obtain a graphic readout with | | | both ECG and RAP tracings | | | | | | ECG: Electrical | | | | | | RAP: Mechanical (end-inspiration | | | to eliminate intrathoracic | | | pressure) | | | | | | - - - | | | | | | CVP PCWP | | | --- ------------- ------------- | | | a PR interval End of QRS | | | c End of QRS ST Segment | | | v End of T TP Interval | +-----------------------------------+-----------------------------------+ +-----------------------------------+-----------------------------------+ | Measuring waveforms | Accuracy requires reading | | | waveforms at **end-expiration** | | | when pleural pressure is it the | | | lowest level | | | | | | Measurement should be done from | | | an **analog tracing that includes | | | simultaneous ECG tracing** | +-----------------------------------+-----------------------------------+ Identify physiological (such as fever) and pathophysiological conditions (such as pericarditis) that can lead to increases or decreases of a parameter such as CVP, PA, SVR etc.. as described in supplemental reading (Wagner Ch 12) ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- +-----------------+-----------------+-----------------+-----------------+ | Parameter | \+ | Increase | Decrease | +=================+=================+=================+=================+ | CVP/RAP | Measures right | **HF** | **Hypovolemia** | | | atrial pressure | | | | | (RAP) | → fluid | → dehydration, | | | | overload, | hemorrhage, | | | R heart preload | decrease venous | severe burns | | | & fluid volume | return | | | | status | | → Low BV = low | | | | **Pericarditis* | CVP | | | | * | | | | | | **Vasodilation* | | | | → Inflammation | * | | | | of pericardium, | | | | | restricts heart | → sepsis, | | | | | anaphylaxis | | | | **Fluid | | | | | overload** | → Decreased | | | | | venous return | | | | → Excess IV | | | | | fluids | **Decreased | | | | | BV** | | | | **Tension | | | | | pneumothorax** | → Low BV = low | | | | | CVP | | | | → Increased | | | | | thoracic | | | | | pressure | | | | | compresses | | | | | heart | | | | | | | | | | **Increased | | | | | BV** | | | | | | | | | | → high BV = | | | | | high CVP | | | | | | | | | | **Pulmonary | | | | | problems** | | | | | | | | | | → Backup | | | | | | | | | | (Squeezing the | | | | | balloon) | | +-----------------+-----------------+-----------------+-----------------+ | PA | Measures | **Pulmonary | **Hypovolemia** | | | pulmonary | HTN** | | | | artery | | → Decreased BV | | | pressure, right | → Increase | = decreased | | | ventricular | resistance in | pressure in | | | preload, | pulmonary | pulmonary | | | pulmonary | arteries | arteries | | | circulation | | | | | status | **Left HF** | **Vasodilation* | | | | | * | | | Evaluate for | → Blood backs | | | | pulmonary HTN, | up into the | → Sepsis | | | HF, lung issues | pulmonary | | | | | circulation | → Vasodilation | | | | | = decreased PAP | | | | **COPD** | | | | | | **Decreased | | | | → Increased | blood flow** | | | | resistance in | | | | | the pulmonary | → low flow = | | | | vasculature | low PAP | | | | | | | | | **Increased | | | | | blood flow** | | | | | | | | | | → High flow = | | | | | high PAP | | +-----------------+-----------------+-----------------+-----------------+ | SVR | Represents | **HTN** | **Sepsis** | | | resistance in | | | | | systemic | → High BP | → Widespread | | | arterial | increases | vasodilation + | | | circulation | resistance | decreased | | | | | resistance | | | Reflects left | **Vasoconstrict | | | | ventricular | ion** | **Anaphylaxis** | | | afterload | | | | | | → Hypothermia, | → Vasodilation | | | Assess vascular | vasopressors | | | | tone and CO | | **Neurogenic | | | (Shock, | **Aortic | shock** | | | vasodilation) | stenosis** | | | | | | → Loss of | | | | → Narrowing | sympathetic | | | | aortic valve = | tone = | | | | increased | vasodilation | | | | resistance | | | | | | **PNS** | | | | **SNS** | | | | | | → PNS stim = | | | | → SNS stim = | low SVR | | | | high SVR | | +-----------------+-----------------+-----------------+-----------------+ Septic shock: 2 phases -- -- -- -- Formulas to know: Cardiac Output (CO) and mean arterial pressure (MAP). ----------------------------------------------------------------------- +-----------------------------------+-----------------------------------+ | Cardiac output (CO) | Amount of blood pumped by the | | | heart per minute | | | | | | 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 = SBP + 2(DBP)/3** | | | | | | - - | +-----------------------------------+-----------------------------------+ Normal ranges to memorize: CVP, and cardiac index, MAP ------------------------------------------------------ CVP Normal: 2-6 mm Hg, mean pressure --------------- ------------------------------------ Cardiac Index Normal range is 2.4-4.0 L/min/m^2^ MAP 70 - 90 mm Hg Describe steps for safe care and removal of a central line catheter. -------------------------------------------------------------------- Describe steps for safe removal of arterial line catheter. ----------------------------------------------------------  +-----------------------------------+-----------------------------------+ | Central line catheter care | Assess system | | | | | | - - - - - | | | | | | Prevent CLABSI | | | | | | - - - | | | | | | - | +===================================+===================================+ | Central line catheter removal | - - - - | | | | | | → STERILE gloves | | | | | | - - - - - - - | | | | | | - - - | +-----------------------------------+-----------------------------------+ | Arterial line catheter removal | Insertion sites | | | | | | - - - - | | | | | | Insertion | | | | | | - - - - | | | | | | Removal | | | | | | - - | | | | | | - - - - - - - - | | | | | | - | +-----------------------------------+-----------------------------------+