Académique Documents
Professionnel Documents
Culture Documents
Part I
(ABP, CVP, Ao)
MICU Competencies
2006-2007
1
Noninvasive BP
Heart Rate, pulses
Mental Status
Skin Temperature
Capillary Refill
Urine Output
Mottling (absent)
3
small
Too
Indications for
Arterial Blood Pressure
Frequent titration of vasoactive drips
Unstable blood pressures
Frequent ABGs or labs
Unable to obtain Non-invasive BP
6
Supplies to Gather
Arterial Catheter
Pressure Tubing
Pressure Bag
Flush 500cc NS
Pressure Cable
Supplies to Gather
Sterile Gown (2)
Chlorhexidine Swabs
Sterile Gloves
Mask
Potential Complications
Associated With Arterial Lines
Hemorrhage
Air Emboli
Infection
Altered Skin Integrity
Impaired Circulation
10
Documentation
Insertion procedure note
ABP readings as ordered
Neurovascular checks every two hours
(in musculoskeletal assessment of HED)
Pressure line flush amounts (3ml/hr)
Tubing and dressing changes
11
12
Phlebostatic Axis
4th intercostal space, mid-axillary line
Level of the atria
15
16
Dynamic Flush
17
System Maintenance
Change tubing and fluid bag q 96hrs
No pressors through CVP port
Antibiotics, NS boluses, blood, & IV pushes
are allowed through the CVP line
18
Troubleshooting
Improper set-up and equipment malfunction
are the primary causes for hemodynamic
monitoring problems
Retracing the set-up process or tubing
(patient to monitor) may identify the problem
and solution quickly
Use your staff resources: Help All, Charge
Nurse, Educator, Preceptors, MICU experts
19
Troubleshooting
Damped Waveforms
Pressure bag inflated to 300 mmHg
Reposition extremity or patient
Verify appropriate scale
Flush or aspirate line
Check or replace module or cable
20
Troubleshooting
Inability to obtain/zero waveform
Connections between cable & monitor
Position of stopcocks
Retry zeroing after above adjustments
21
22
Supplies to Gather
Pressure Cable
Pressure Tubing
Connector
(Edwards Lifesciences, n.d.)
23
Setting up the Ao
Discard infusion spike end & cap port
Connect pressure tubing to vent tubing
(using connector opposite heating cable)
Connect cables
Zero the tubing (leveling not necessary)
24
Troubleshooting Ao
Do not prime tubing with fluids!
Damping will occur with fluid or secretions
To evacuate any fluids, disconnect pressure
tubing from vent tubing and push air through
the pressure tubing with a 10 ml syringe
connected at one end until fluid-free
25
Pressure Measurement
1) Record Ao and CVP on the same strip
2) Find end-expiration by drawing a vertical line with a straight edge 200 ms prior to the rise or dip in Ao (1 large box)
associated with a breath.
3) Draw a horizontal line through the visually assessed average vascular pressure starting at end-expiration going backward
200 ms (1 large box).
4) Read the pressure at the horizontal line.
15
10
5
0
5
CVP=13
26
Assist-Control
CVP
Ao
200 ms
200 ms
27
CVP
Ao
200 ms
200 ms
28
Ao
200 ms
CVP
200 ms
29
40
30
20
10
0
10
Incorrect method!
This point was
identified as endexpiration for a pt.
who did not have an
Ao set up.
Correct method!
30 sec after the above
tracing, Ao was added & true
end-expiration clearly
identified.
30
31
15
10
5
0
5
CVP=13
32
Summary
Record Ao with CVP
Read mean CVP at end-expiration as
described. No need read vascular pressure at
any particular time in the cardiac cycle
33
Documentation of CVP
Include on waveform strip
35