Cardiac output value is?
4-8L/min
what is CO?
the amount of blood pumped out by the ventricle every minute.
Cardiac Index value?
what does CI mean?
2.5-4.2L/min
CO individualized to pt body surface area. Accounts for body size
What is the value of Central venous pressure?
CVP
2-6mmhg
what does CVP mean? What is it used for? and what device is used to
measure this value?
It is pressure created by volume of blood in the R side of the heart.
RAP(right atrial pressure),
It is used to check fluid balance (preload) and responsiveness to
fluid administration.
Central venous catheter is used to measure CVP.
you can administer meds/fluids and draw blood from.
What is the value for pulmonary artery occlusion pressure?
PAOP
8-12mmHg
When is PAOP used?
It is check with a SwanGanz pulmonary artery catheter that is
inserted in the pulmonary artery and checks your L ventricle pressure.
Low PAOP: means reduction of blood in left
ventricular blood volume for contraction. Can be from dehydration,
diuretic therapy and hemorrhage.
High PAOP: means increase blood volume. Can be from
fluid overload or renal failure.
What is the value for Pulmonary artery pressure systole?
PAS
15-25mmHg
Value for PAD?
8-15mmHg
What is Pulmonary artery pressure (PAP)
(systole (PAS) and diastole (PAD)?
Pulsatile pressure in the pulmonary artery.
What is the value of Systemic vascular resistance?
SVR
770-1500 dynes/sec
What does SVR mean?
The resistance that the left ventricle must must overcome to open the
aortic valve into the body for systemic circulation. Usually if SVR is
high--> CO is low.
What is SVR used for?
It is an invasive hemodynamic monitoring that monitors your after load.
What is the value for Mixed venous oxygen saturation?
SvO2
60%-75%
What does SvO2 mean?
where is it measured?
and why would we use it?
Provides and assessment of balance between oxygen supply and demand.
It is measured in the pulmonary artery
We would use it to determine Oxygen consumption in the blood.
Pts w/ Trauma, Respiratory distress syndrome, sepsis may benefit
from this.
What does it mean when SvO2 is low?
Lower values indicate that there is a decreased O2 supply from low
Hgb, which then means low CO, low SaO2 and/or increased O2 consumption.
What is the value of MAP?
Mean arterial pressure
70-100mmHg
What is MAP?
The mean perfusion pressure throughout cardiac cycle
What types of Noninvasive monitoring is there?
BP, JVD pressure and lab tests such as lactate (lactic acid).
Lactate value: .5-1.5mEq
How can you check JVD? and what does checking JVD tell you?
You can check JVD by having the pt sit supine at 30 degrees and have
them turn their head to their left and you sitting on their right. If
it is not seen, then apply light pressure to the jugular vein and if
you see any fullness then that means fluid overload---> high CVP.
What 3 Nursing Diagnoses qualify a pt for hemodynamic monitoring?
Ineffective tissue perfusion
Decreased CO
Fluid volume excess/deficit.
What are the 3 types of invasive equipment for invasive monitoring?
Arterial line
Central venous catheter
Pulmonary artery catheter (sawn-guanz)
What types of complications can arise from the invasive hemodynamic monitoring?
Thrombosis, hematoma, infection, bleeding, pnuemothorax, cardiac
dysrhythmias, and pericardial tamponade.
What does an Arterial line do?
treats hemodynamic instability.
Asses vasoactive meds
used for blood samples
can be used with SV device.
What are complications of having an arterial line?
Thrombosis, blood loss and infection.
never administer meds through via arterial line.
What does a central venous catheter do?
Measures R heart filling pressures. Right sided cardiac function.
Gives fluid status
you can administer large volume fluids or meds or blood samples.
Low RAP=hypovolemic
High RAP=fluid overload. (causes: mechanical vent. aggressive
administration of IV fluids)
Confirm placement of catheter.
Complications for CVC?
CLABSI which can lead to sepsis.
Obtain a chest xray after insertion to confirm placement.
What is a pulmonary artery catheter used for?
To assess L ventricular filling pressures of heart
measures PAOP pressures (distal port)(can be used for blood samples).
Assess PAD/PAS/PAOP(inflate ballon 1.5mL air(no longer then
8/10secs; gives L ventricular function) record at end of expiration.
Assess SvO2
measures CO
Thermistor connector: checks temperature of blood
can be used for administration of fluids/meds (proximal port)
Confirm placement of catheter.
for Mech Vent pts monitor during inspiration.
What do you do when your pt has an invasive hemodynamic monitoring?
Document insertion site
Changes dressings and check for signs of infection
Maintain patency by flushing after each use
keep tubing kink free
ensure alarms are on
how do you prepare pt for PA catheter insertion?
obtain consent; education on pt positioning, explain procedure and
what they are going to expect.
Pt's bed placed in Trendelenburg (to promote venous filling in
upper body for easier insertion).
If pt has respiratory distress/increased intracranial pressure
then DONT.
Document depth of catheter at insertion site.
What do you monitor for during insertion of PA catheter?
RR & effort
HR & rhythm
assess for dysrhythmias. (ventricular dysrthmias may occur)
record: RAP right ventricular pressure, PAOP.
PAOP signals the end of insertion (deflate ballon)
Only inflate when PAOP is needed!!!!
Nursing role in PA catheter care?
Monitor RAP, PAP, PAOP.
Maintain catheter position.
Make sure balloon is always deflated (unless you're checking PAOP)
What does the transducer do in hemodynamic monitoring?
translates intrvascular pressure changes into wave forms and data.
Always zero the transducer for accurate readings
what is a stopcock used for?
the threeway stopcock is attached to the transducer and is used for
the referencing point for zeroing and leveling the system.
what are the four major components for validating the accuracy of
hemodynamic monitoring?
1. positioning the pt
2. zeroing the stopcock to the phlebostatic axis (leveling the
air-fluid interface)
3. zeroing the transducer
4. perform the square wave test
What type of abnormal dynamic response can you have with an
Overdamped system?
blood clots after you withdrawl blood samples:
disconnect tubing from pt then you aspirate to remove clots and any
air from the catheter/line (transducer); flush if needed.
Compliant tubing: change tubing if necessary
loose connections:
kinks in tubing: make sure all tubes are free of kink
what types of problems can arise when you get an Overdamped system
with you hemodynamic monitoring with your pts?
tube is too long: normal length should be 36-48 inches
Small-bore tubing: replace with a large bore
At what pressure does the pressure bag need to be at?
300
what are the steps for setting up a pt for hemodynamic monitoring?
Position pt HOB 30 degrees
prime transducer
zero the stopcock to the phlebostatic axis
level transducer--> zero transducer
stopcock is turned to neutral position
then you do a square wave test to test to see if it is giving
accurate readings.
What are the steps for the allens test?
Ask pt to form tight fist
occlude radial artery and ulnar at the same time (10 secs)
ask pt to open fist
release ULNAR artery first
if ulnar artery circulation returns in 5 secs then its good if more
then 10 secs then its doesn't qualify for arterial line!
for the pulmonary catheter what would you see in the xray in the
right atrium?
the proximal port and injectate port