CVP (central venous pressure)
Normal: 2-6 mmHg (or 8-12cm H2O)
Measure of pressure in vena cava/R. Atrium.
Estimation of preload and R. Atrial pressure
>6 = Fluid overload = lasix tx
<2 = Hypovolemia = Infuse volume/blood
Pulmonary artery pressure(Swan-Ganz)
Pressure sensor via catheter in the artery b/w heart and lungs
Dx HF, shock etiology, response to medical interventions
Red Flag: Ensure that balloon is deflated after measuring pulmonary artery wedge
pressure to ensure the catheter has returned to its normal position. Verified by
evaluating pulmonary artery pressure waveform on bedside monitor.
Intra-Arterial Blood Pressure
Obtain direct and continuous BP in critical pts with sever hypo or hypertension.
Thin hollow tube placed in artery on wrist/groin/etc.
ABG and blood samples only, no fluids/meds.
Sterile procedure. Concerned with CLABSI 72-96hrs with line .
Risks= pneumothorax. get CXR post insertion esp. with superior vena cava insertion
Pressure bag priming must be accurate before spiking bag.
Intra-Arterial Blood Pressure Nsg Interventions
Wash hands with soap/water ir EtOH based hand rub before/after contact with the
catheter
Cleanse skin with CHG
Cover with sterile gauze/sterile transparent semipermeable dressing.
Change gauze Q2days, transparent Q7days, or PRN if soiled/damp/loose.
No topical Abx/creams
No dextrose in system
Assess Cath. site during dressing change/palpation through intact dressing
Remove dressing ifs tender, fever, or sx of local or blood infection
Replace system Q96hrs or pre facility policy
,Do not submerge in water when bathing, shower shield when showering
Edu pt to report any new discomforts to Cath. site.
Phlebostatic Axis
An external landmark that is the intersection of two imaginary lines drawn on the chest
used to position the zero reference on the transducer level with the atria
Measurements can be taken at 0, 30, 60 degrees and transducer must be repositioned
after each position change.
Complications in Hemodynamic monitoring
Pneumothorax
Infection = CLABSI- lab-confirmed bloodstream infection not related to an infection at
another site that dev. w/in 48hrs of central line placement.
Air embolism
cardiac conduction system
P wave: electrical impulse starting in SA node , spreading through atria (atrial
depolarization)
PR Interval: beginning of P wave to beginning of QRS complex; atrial depolarization,
conduction through AV node before ventricular depolarization
QRS Complex: ventricular depolarization (contracting)
ST segment: end of QRS complex to beginning of T wave; ventricular
repolarization
T wave: ventricular repolarization (resting)
QT interval: beginning of QRS complex to end of T wave; total time for ventricular
depolarization and repolarization
Sinus Rhythm strip
SNS Effect on Hemodynamics
Catecholamines released increase HR -> increase conduction speed/strength/quicker
relaxation.
Meds that cause: Bronchodilators like Albuterol, Vasopressors, Atropine
ANS Effect on Hemodynamics
Decrease HR -> decreased action potential speed/contraction
Causes:
- Vagal maneuver
-Drugs: Procainamide, A-Blockers, B-Blockers, Amiodarone, Sotalol
Sinus Tachycardia
>100 bpm but <120
PR Interval = 0.12-0.20sec
Sympathetic activation and decreased Parasymp. activity
Compensatory response to increase demand for CO/SV
Etiology:
-Fever, Hyperthyroidism, Hypoxia, Anxiety, blood loss, increased metabolism, low BP,
pain
Dx: EKG
Sinus Tachycardia Strip
Sinus Tachycardia Nrsg Interventions
Assess and tx cause
Vagal stim. = bearing down
, Withhold drugs which cause tachycardia = Atropine
Monitor for hemodynamic instability
Sinus Tachycardia Med. Mgmt
Determined by severity of sx and directed and ID-ing/removing the cause
Synchronized Cardioversion = low energy (30-60joules) shock synchronized to the QRS
complex [tx of choice]
Ca Channel Blocker: Adenosine
-decreased Ca in SA and AV nodes = decreased HR and AV conduction
B-Adrenergic Blockers: Sotalol , Popranolol
-decreased adrenaline, blocks SNS, decrease BP
Sinus Bradycardia
<60 bpm
-Slowed impulse generated by the sinus node
SA is the heart's pacemaker with normal rate at 60-100BPM, AV rate is 40-60BPM
-Not tx-ed if pt is asymptomatic
Interpretation Characteristics
• Rate: Less than 60 bpm
• Rhythm: Regular
• QRS Shape: Normal
• P Wave: Normal and Consistent Shape, always infront of QRS
• PR Interval: 0.12-0.20 seconds
Sinus Bradycardia Etiology
- Increased parasympathetic activity
- Lower metabolic needs: Sleep, Physically Trained Individuals (lowered O2 demands
d/t peak body performance), hypothyroid
- Vagal stimulation: vomiting, suctioning
- Drugs: Ca Channel blockers (Amiodarone, Nifedipine) Beta blockers (-lol), Lithium,
Histamine blockers, Anti-Depression Drugs, NM blockers, Amphetamines.
-Atropine is 1st line tx for tachycardia but may cause bradycardia
- Increased Stroke Volume (volume of blood ejected with contraction)
- HTN
Sinus Bradycardia Treatment
-ID cause, stop vagal maneuver, Hold Rate Slowing Drugs (Digoxin, Beta Blockers),
-Stop Valsalva Maneuver
Medications:
- Adrenergic Receptor (Epinephrine)
- Anticholinergic (Atropine): IV bolus, repeated Q3-5 min until max dose of 3 mg given
- Emergency Transcutaneous Pacing (if meds don't
work): delivering pulses of electric current through the
patient's chest, stimulating the heart to contract (Temporary till pacemaker placed)
Atrial Fibrillation (A-Fib)
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