Invasive Lines T3

  1. Types of lines we transport...
    • 1. Arterial (A-lines, Art-Line)
    • 2. Central Venous Presure (CVP)
    • 3. Pulmonary Artery Catheter (PA, Swan-Ganz)
    • (These lines should be transduced and monitored in most cases.)
  2. General Principles
    • 1. The pressure bag is inflated ro 300mm/Hg ("green zone")
    • 2. monitor invasive line
    • 3. Whenever possible get rid of extra stuff
    • 4. Must appropriately position, zero and scale
  3. What to monitor with invasive lines?
    • 1. distal perfusion and sensation
    • 2. infection
    • 3. hemorrhage
    • 4. occlusion
  4. Arterial Lines Facts
    • 1. catheter is in an artery opposing flow
    • 2. monitors real time BP
    • 3. very helpful for patients with multiple vasoactive infusions or if critically unstable
    • 4. can be used for serial arterial sampling
    • 5. usually the RED readout on a monitor
  5. Common arterial line sites
    • 1. radial
    • 2. brachial
    • 3. femoral
  6. Zeroing Arterial Line
    • When initiating monitoring, switching monitors or any disconnection the system must be zeroed.
    • 1. open the transducer to ambient pressure (open to air, closed to patient)
    • 2. Assure the transducer is at the phlebostatic axis
    • 3. remove the cap
    • 4. select "Zero" on the monitor
    • 5. may need to "scale" the waveform
  7. Phlebostatic Axis
    4th ICS mid axillary line
  8. Performing the Square Wave Test
    • (also called the Fast Flush or Sine Wave Test)
    • 1. pull the tail to flush the system and produce a square sine wave
    • 2. evaluate for dampening
    • Generally one or two oscillations prior to return to baseline 
    • under-dampened: > 1
    • over-dampened: no oscillation
  9. Arterial Line Complications
    • 1. dampened waveforms
    • 2. loss of vibrating energy due to resistance in the transducer system
    • - Under-dampened (exaggerated response) causes false high systolic and false low systolic readings
    • - Over-dampened (blunted response) causes false low systolic and false high diastolic readings
    • o clots
    • o positional catheters
    • o dislodged catheters
    • o low BP/high BP
    • o loose connections
    • o air in system
    • o poor tubing compliance
  10. Central Venous Pressure (CVP)
    • 1. potentially a measurement of preload
    • - high = fluid overload or right sided disease (pulmonary pHTN, stenosis, high PEEP, etc)
    • - normal is variable but generally 0-6 cm/H2O
    • 2. Usually verified placement by x-ray in the SVC 2cm distal to the RA
    • 3. generally the BLUE waveform on a monitor
  11. Pulmonary Artery Catheter (PA)
    • Measures numerous parameters in the ICU (we can only measure PA pressures in transport)
    • - at Temple, generally used to guide therapy in the first 25 hours and the DC'd
    • - should get a "set of numbers" prior to transport
    • - generally the PURPLE waveform on the monitor
  12. "Normal" Hemodynamic Values
    CO/CI
    2.5 - 4.2 L/Min
  13. "Normal" Hemodynamic Values
    SVR/SVI
    900 - 1300 dynes/sec/cm
  14. "Normal" Hemodynamic Values
    LVEF
    50-70%
  15. "Normal" Hemodynamic Values
    SV/SVI
    50-100ml
  16. "Normal" Hemodynamic Values
    PVR
    155-255 dynes/sec/cm
  17. "Normal" Hemodynamic Values
    PCWP
    4-12 mm/Hg
  18. Right Heart Failure
    ⇧ CVP ⇩ CI ⇧ PVR
  19. Left Heart Failure
    ⇧ PCWP ⇩ CI ⇧ SVR
  20. Pericardial Tamponade
    ⇧ PWCP ⇧ SVR ⇩ CI
  21. Hypovolemia
    ⇩ CVP ⇩ PCWP ⇩ CI ⇧ SVR
  22. Cardiogenic Shock
    ⇧ PCWP ⇩ CI ⇧ SVR
  23. Septic Shock
    ⇩ PCWP ⇧ CI ⇩ SVR
  24. Care for a PA Catheter
    • Generally same as an ART Line but...
    • 1. check for the balloon status - open vs wedged
    • 2. monitor for the ectopy, dysrhythmia or a change in the waveform
    • 3. Monitor the depth of the catheter
    • 4. Observe for "catheter whip" (excessive movement of the catheter tip caused by cardiac contractions - use PAP)
  25. Ventriculostomy
    • - not a frequent transport
    • - needs to be fairly aseptic
    • - NEVER infuse a ventric
    • - transducer system is leveled at the Foramen of Monroe (tragus of the ear/auditory meatus) and corresponds to the 3rd cerebral ventrile
    • - Normal ICP 0-15, establish a threshold ICP
    • - CPP (MAP - ICP) >60 mm/Hg
    • (neurosurgical procedure that involves creating a hole ("stomy") within a cerebral ventricle for drainage. It is done by surgically penetrating the skull, dura mater, and brain such that the ventricle of the brain is accessed.)
  26. Ventriculostomy
    Drainage and Monitoring
    • 1. can not monitor and drain simultaneously
    • 2. typically we monitor or drain as clinically indicated or as ordered
    • 3. clamp during coughing, vomiting, movement or suctioning
    • 4. Drainage system will be ordered at a specific level above zero point (+5 cm, +10 cm, etc)
  27. Ventriculostomy

    Drainage and Monitoring
    • 1. 
    • 2. assess ICP for drainage every 15 minutes
    • 3. for herniation drain 10 ml and reassess
    • 4. maintain adequate, CPP, sedation/pain management, positioning
Author
thom.mccusker@gmail.com
ID
335019
Card Set
Invasive Lines T3
Description
Invasive Lines
Updated