The Basics
Hemodynamic Monitoring consists of: Invasive, Non-invasive, or both?
Both
What does an arterial line measure?
Blood pressure (invasively)
What does a pulmonary artery catheter measure?
Cardiac pressures
Normal value 2-6 mm HG (for testing purposes 4-8 mm HG)
What is CVP (Central Venous Pressure)?
A PA catheter has just been inserted. What is the nurse's primary intervention?
A) Call for a chest x-ray
B) Flush the catheter with heparinized solution
C) Place a bulky dressing over the catheter site
D) Draw 30mL of blood back
A) Call for a chest x-ray
What is "the volume of blood pumped out of the heart in one minute" called?
Cardiac Output
Arterial line sites include (Select all that apply):
A) Brachial
B) Radial
C) Internal Jugular
D) Femoral
E) Subclavian
A) Brachial
B) Radial
D) Femoral
A) Brachial
B) Radial
C) Internal Jugular
D) Femoral
E) Subclavian
C) Internal Jugular
D) Femoral
E) Subclavian
Normal value 15-25/8-15
What is PAP (Pulmonary Artery Pressure)?
The nurse is caring for a patient with a left subclavian central venous catheter (CVC) and a left radial arterial line. Which assessment finding by the nurse requires immediate action?
A) A damaged arterial line waveform
B) Numbness and tingling in the left hand
C) Slight bloody drainage at the subclavian insertion site
D) Slight redness at the subclavian insertion site
B) Numbness and tingling in the left hand
Measures the pressure of the blood in the right atrium
What is central venous pressure/CVP?
What test is performed prior to inserting an arterial line to ensure normal blood flow to the hands?
Allen's Test
What is the best way to ensure placement of a pulmonary artery catheter?
Chest x-ray
Normal value is 8-12
What is PAOP/PAWP (pulmonary artery occlusion pressure or wedge pressure)?
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which assessment finding 2 hours after insertion by the nurse warrants immediate action?
A) Diminished breath sounds over left lung field
B) Localized pain at catheter insertion site
C) Measured central venous pressure of 5mm Hg
D) Slight bloody drainage around insertion site
A) Diminished breath sounds over left lung field
What is the reference point for zeroing the hemodynamic monitoring device called?
Phlebostatic axis
This ensures accuracy of high pressure hemodynamic lines
What is zeroing line or square wave test?
Name 3 complications that could occur when inserting a pulmonary artery catheter.
1) Balloon rupture
2) Arrhythmia
3) Pulmonary infarction
4) Pulmonary artery rupture
Normal value is 4-8 L/min
What is cardiac output/CO?
The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of a catheter-associated bloodstream infection (CLABSI)?
A) Review daily the necessity of the central venous catheter
B) Cleanse the insertion site daily with isopropyl alcohol
C) Change the pressurized tubing system and flush bag daily
D) Maintain a pressure of 300mm Hg in the flush bag
A) Review daily the necessity of the central venous catheter
Name the three most common types of invasive hemodynamic monitoring.
1) Arterial Line
2) Pulmonary Artery Catheters
3) CVC's (central venous catheters/central lines)
1) Vascular occlusion
2) Thrombosis
3) Ischemia
4) Hematoma formation
5) Local infection
6) Sepsis
Explain the "wedge" in a pulmonary artery catheter.
Most catheters have an inflatable balloon at the tip, which allows placement into a pulmonary vessel when inflated (wedged) in order to provide indirect measurement of the left atrium pressures. You may see the abbreviation PWP (pulmonary wedge pressure) or PCW (pulmonary capillary wedge).
Normal value is greater than 65 to ensure adequate organ perfusion
What is MAP/mean arterial pressure?
The nurse is caring for a patient with a left radial arterial line and a pulmonary artery catheter inserted into the right subclavian vein. Which action by the nurse best ensures the safety of the patient being monitored with invasive hemodynamic monitoring tests?
A) Document all waveform values
B) Limit the pressure tubing length
C) Zero reference the system daily
D) Ensure alarm limits are turned on
D) Ensure alarm limits are turned on