NR 340 Critical Care Exam 2 Revised Study Guide Page 1 of 9
Hemodynamic Monitoring: Chapter 8 pgs 140-169
Goal of Hemodynamic monitoring is to
... [Show More] maintain adequate tissue perfusion.
Safety issues and troubleshooting with hemodynamic monitoring lines:
Arterial lines: sites= radial, femoral
o Indications: indicated for hemodynamic instability, assess efficacy of vasoactive meds, frequent ABG
analysis
o Complications:
1. Infection: infection may occur if the catheter is left in place for a prolonged period; however,
routine replacement of the catheter is not recommended, unless infection is suspected.
2. Hemorrhage from the site of insertion: The nurse should apply direct pressure and notify the provider.
3. Thrombosis in the cannula: A thrombosis in the cannula is usually suspected when the waveform is
damped. The nurse should aspirate and discard blood (and the thrombus) from the cannula then fast flush
to clear the tubing of blood.
4. Tissue ischemia in the cannulated extremity: Notify the provider. The nurse should continue to assess
for worsening of the ischemia indicated by delayed capillary refill, pallor or cyanosis, reduction in pulses
distal to cannula, and cool temperature.
5. Disconnection/dislodgment: blood loss is usually due to sudden dislodgement of the catheter from
the artery or from a disconnection in the tubing.
6. Overdamping (BOX 8-3 pg 153) : patient has an occlusion
Blood clots left in the catheter after getting a blood sample, air bubbles at any point between the
catheter tip and the transducer.
Tx: flush the system or aspirate, disconnecting from the patient if needed to adequately flush
the system to remove clots or air bubbles
Compliant tubing: change to noncompliant tubing or commercially available tubing system.
Loose connections: ensure all connections are secure
Kinks in tubing system: Straighten tubing
7. Underdamping (Box 8-3, page 153) –
Excessive tubing length (>36-48”)
Tx: remove extraneous tubing, stopcocks, or extensions
Small bore tubing
Tx: Replace small bore tubing with a large bore set
Cause unknown
Add a damping device into the system to reduce artifact
PA catheters: placed on the left midaxillary 4th intercostal space (Phlebostic axis)
o Indication
identify and treat cause of hemodynamic instability
assess pulmonary artery pressure
Assess mixed venous oxygen saturation SvO2
Directly measures CO
o Complications:
Ventricular dysrhythmias: Notify the provider. If patient is unstable administer anti-arrhythmic per
standing orders.
Pulmonary capillary rupture, pulmonary infarction: S/S include blood-tinged or frank bloody
sputum; decreased SpO2; respiratory distress. Notify the provider immediately. Provide supplementary
oxygen and be prepared to support ventilation if necessary.
Pneumothorax/hemothorax: S/S include dyspnea, tachypnea, tachycardia, decreased breath sounds on
affected side, possible hypotension, decreased oxygen saturation, possible tracheal deviation away from
affected side. Notify the provider, provide supplementary oxygen, and prepare for assisting the provider
with a needle decompression or chest tube insertion.
Infection: Notify the provider. The nurse should anticipate that the provider will discontinue the
NR 340 Critical Care Exam 2 Revised Study Guide Page 2 of 9
infected cannula and should be prepared for a catheter insertion in another location.
Hematoma: Suspect vessel laceration if a hematoma/swelling occurs around the site of insertion. Apply
direct pressure and notify the provider. Closely monitor blood pressure, heart rate, respiratory rate, and
pulse oximetry.
PA catheter knotting: If PA catheter is knotted the nurse should never attempt to remove the PA
catheter. Notify the provider.
Normal hemodynamic values (Table 8-1 page 147) –** I will use this table for normal values on the test. CVP
and CO values are from the HESI book**
o Preload: the volume of fluid coming into the atrium; degree of stretch.
o Afterload: Resistance the ventricles overcome when they deliver SV (eject blood); resistance= the ease with
which the fluid flows through the lumen of a vessel.
o Aortic pressure: Systolic – 100-140mmHg; diastolic – 60-90mmHg
o MAP – Mean arterial pressure 70 – 105 mmHg (Table 8-2, page 163)
o Pulmonary artery pressure (PAP): Pressure created by the pulmonary system on the pulmonary pressures
PAS= Systolic – 15-25mmHg; PAD= diastolic – 8-15 mmHg
o PAOP/PAWP – Pressure created by volume of blood in left heart
8-12mmHg
o SVR – Resistance that the left ventricle must overcome to eject a volume of blood; generally as SVR
increases, CO falls
Left ventricular pressure – 110-130mmHg systolic, 8-12mmHg diastolic
o CVP –central venous pressure= Pressure created by the volume of blood in the right heart; used to guide
assessment of fluid balance and responsiveness
4-8 mmHg (Table 8-1 on page 147 has the value as 2-6 mmHg) 770 – 1500 dynes/sec/cm-5
o PVR – Pulmonary Vascular Resistance: Resistance that the right ventricle must overcome to eject a volume
of blood, normally 1/6 of SVR 20 – 120 dynes/sec/cm-5
o CO –Amount of blood pumped out by a ventricle every minute. SVXHR= CO Fluid overload= decreases
CO; Fluid deficit= decreases CO; 4-6L/min
4 – 6 L/min (Table 8-1 on page 147 has the value as 4-8 L/min
o CI –is individualized to patient body surface area. Output/ body surface area 2.5 – 4.5 L/min/m [Show Less]