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NURS 486 Hemodynamics
#1 place for PICC - ansBrachial Basilic Cephalic (more DVTs→ last resort) 3 way stop cock "zero" - ansSame as atmospheric pressure If bag blown up → fluids will flow faster but not fast flush 3 way stop cock DOWN - ans(towards pt) Release ALL air from bag "Fast flush" Then normal gravity drip 3 way stop cock UP - ans(towards bag) Pressure pushing up/blowing Blood pulls back A-line - ansIn radial or femoral artery DR inserts Afterload - ansThe resistance that you are pushing towards Ventricle must overcome with each contraction Depends on how open/closed arteries are Afterload is affected by - ansHGB PVR SVR BP Benefits of A-line - ansBeat by beat BP Good for titrating drips blood products - ansHbg PRBC Platelets
Cardiac Index - ansTakes BMI into account Normal: 2.5-4 L/min/m Cardiac Output - ansHR x SV Normal: 4/6 L/min Important: Output of blood=oxygen to body Central Line - ansIn IJ or SVC Need CXR to confirm placement If incorrectly → pneumothorax Specialty CVCs = swan (goes into heart itself) Central Line used for - ansMeds Draw sample CVP IVF/TPN/Vasopressin Central venous pressure (CVP) - ansBlood pressure in the venae cavae (near the right atrium) Reflects: amount of blood returning to the heart ability of the heart to pump the blood back into the arterial system Normal: 2- 8 mmHg Can be falsely high Fluids too fast clear sight needs to be changes - ansq 72 hours Clearsight measures - ansHR BP MAP Continuous CO SV SVV SVR
Cortis/Introducer: - ansBig guy (large hole) Must run fluids with it or it will back up and clot Needed to introduce: Swan Pacemaker Lots of goodies can go through it Diastole - ansLower pressure relaxation of ventricles during filling DO2 - ansDelivery of O2 to tissues Less oxygen if cant deliver EV1000 Clinical Platform - ansGives you continuous SCVO -measured in SVC through central line -only measures venous blood returning from the upper half of the body Regional monitor (just head and neck) Not as good as swan (not as invasive) Can also run multiple things like CO, SVV, SV, MAP Flowtrack measures - ansBP and HR through A-line -Beat by beat Continuous CO SV and SVV Two pigtails and flowtrack tubing Heart valves create - ansb/dub (S1/S2) Keeps blood going right way Need to know patient's baseline Hemodynamic Principles - ansPressure, Flow, Resistance Adjusting to supply and demand Makes sure body is getting what it needs
Hemodynamics car analogy - ansHeart=motor Pumping and getting stuff done Oxygen=gas Mechanically move and circulate throughout body Vascular system=tank When empty= doesn't have volume it needs High CO - ansFever Balanced tachy (100-110) Albuterol Neurogenic shock Sepsis High Diastole - ansAge Disease Obesity High cholesterol Smoking Males high DO2 - ansTransfusion high SVV means - ansHigh= dry (tank not full) High systole - ansPain Stress Anxiety SNS (fight/flight) High VO2 - ansIncreased metabolic demands Shivering
Dehydration Severe tachy → fast HR → no filling → not good squeeze → decrease CO Low dO2 - ansanemia pump is not strong enough Low systole - anstank is empty Anemia Dehydration Sedated Trauma (losing blood) Low VO2 - ansSedation Inactivity Serious pain control HYPOTHERMIA Normal PA wedge pressure - ans6-12 mmHg normal SVO2 - ans60-80% normal SVV - ansNormal: 10-15% PA Wedge Pressure insertion - ans1. Dr puts in
- Blow up ballon (3 mL syringe)
- Make sure blown up all the way so no blood gets through PA
- Know you're in= sawtooth waves
- Reading
- Deflate ballon
- Lock syringe PADP meaning - ansDiastolic Pulmonary Artery Pressure Phlebostatic Axis - ans4th intercostal space at left midaxillary line Preload - ansVolume at end of diastole in ventricles Preload is affected by - ansPaO
CVP
RAP
LVEDP
Pulmonary Artery Catheter (PAC) - ans-SWAN -Gold standard -Very invasive Pulmonary Artery Catheter Insertion - ansIn through neck or chest → into atria → down to ventricles → up to pulmonary artery Pulmonary Artery Occlusion (PA Wedge Pressure) purpose - ansTell you fluid status (lungs) Pulmonary Artery Pressure (PAP): - ansBlood pressure just in pulmonary artery Normal: 15-25/8- 25/15= average Get first pap between these ages Pulmonary Vascular resistance - ansForm right side (lower pressure) Normal: <250 dynes-sec/cm- RAP meaning - ansRight arterial pressure Risks of A-line - ansbroken skin integrity → infection Pulled out → hemorrhage or thrombus Risks of central line - ansCan be malpositioned (flipped up into neck, now can hear flush in neck) Make sure it draws back blood Infection Thrombus Hemorrhage/bleeding DVT Especially with a PICC line (blood cannot get around catheter) RVEDV meaning - ansRight Ventricular End Diastolic Volume
Important that transducer is zeroed to this so it reads correctly If above → BP looks higher If lower → BP looks lower Alarm to tell if outside normal range VO2 - ansoxygen consumption at cellular level What high wedge pressure could be from - ansPulmonary edema ARDS What low wedge pressure could be from - ansdehydration what to do if Right Ventricular Ejection Fraction (RVEF) is LOW - ansTurn up O2 to get better output Transfusion Vasoactive drip What to monitor for with PA Wedge pressure - ansLength of sawn to make sure not sliding in/out When collecting a specimen from a central line - ansPause when running Clamp line before Bc continuous fluids Continuous fluids: Change tubing q96 hours Can leave IV as long as no phlebitis or infiltration When PAC hits PA - anssawtooth When PAC hits RA Pressure will be - ans2-6 mmHg (CVP) Best spot to find CVP When PAC hits RV - anshigher pressure bc ventricles pump When PAC is wedged - ans6- Where do you draw CVC from with a triple lumen? - anscentral port
Which receptors effect after load more? - ansAlpha's Alpha-only drugs: Vasoconstrictors Epi and NE (B1, B2, and alpha) Will cause a lot of effects
