Académique Documents
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STATUS
By
Imran yousafzai
Lecturer, KMU
ARTERIAL LINES
Arterial line
• Hemodynamic monitoring is initiated to assess
the patient’s response to treatment. In many
institutions, this is performed in the intensive
care unit, where an arterial line can be inserted.
• The arterial line enables accurate and continuous
monitoring of blood pressure and provides a port
from which to obtain frequent arterial blood
samples without having to perform repeated
arterial punctures.
WHAT IS AN ARTERIAL LINE?
• AN ARTERIAL LINE IS A
CANNULA USUALLY
POSITIONED IN A
PERIPHERAL ARTERY
• SUCH AS
• Radial artery
• brachial artery
• dorsalis pedis artery
• femoral artery
INDICATIONS FOR USING ARTERIAL
LINE
• Ease of access
• Continuous monitoring of
arterial blood pressure
– if patient is on intropic
drugs
– if patient is on
vasoactive drug
– if patient requires
frequent arterial blood
sampling
COMPLICATIONS ASSOCIATED WITH
ARTERIAL LINES
• HYPOVOLAEMIA
• ACCIDENTAL INTR-ARTERIAL INJECTION OF
DRUGS
• LOCAL DAMAGE TO ARTERY
Nurse Role
• A major role of the nurse is monitoring the
patient’s hemodynamic and cardiac status.
Arterial lines and electrocardiographic
monitoring equipment must be maintained
and functioning properly.
• Changes in hemodynamic, cardiac, and
pulmonary status are documented and
reported promptly.
THE ARTERIAL WAVEFORM
• The arterial waveform
reflects the pressure
generated in the
arteries following
ventricular contraction
and can be described as
having:-
– Peak systolic pressure
– Diastolic pressure
REMOVAL OF ARTERIAL LINE
• THIS IS AN ASEPTIC PROCEDURE
• REMEMBER UNIVERSAL PRECAUTIONS
• THE PROCEDURE SHOULD BE EXPLAINED TO THE PATIENT
• TAKE DRESSING OFF LINE
• REMOVE ARTERIAL LINE ENSURING THAT THE ENTRY SITE IS
COVERED WITH GAUZE
• APPLY DIGITAL PRESSURE FOR AT LEAST 5 MINUTES TO
ENSURE HAEMOSTASIS
• DRESS SITE WITH GAUZE AND MICROPORE
• ASSESS THE PERIPHERAL CIRCULATION AS THROMBOSIS CAN
OCCUR AFTER REMOVAL
CVP Line
WHAT IS A CENTRAL LINE
• It is a catheter that
provides venous access
via the superior vena
cava or right atrium
COMMON CENTRAL LINE INSERTION
SITES
• Right internal jugular
• left internal jugular
• right subclavian
• left subclavian
• femoral (as a last resort)
TYPES OF CENTRAL LINE
• SINGLE LUMEN
• TRIPLE LUMEN
• QUADRUPLE LUMEN
• QUINTUPLE LUMEN
CENTRAL LINES
• Indications for CVP lines are:-
– fluid resuscitation
– Parenteral feeding
– measurement of central venous pressure
– poor venous access
– administration of irritant drugs
Diagram of placement of central venous catheter: the
catheter is tunneled under skin and enters the superior vena
cava into the right side of the heart
Tunneled CVC
CENTRAL VENOUS PRESSURE
MONITORING
• In central venous pressure monitoring, the physician inserts a catheter
through a vein and advances it until its tip lies in or near the right atrium.
• Because no major valves lie at the junction of the vena cava and right atrium,
pressure at end diastole reflects back to the catheter.
• The central venous (CV) line also provides access to a large vessel for rapid,
high-volume fluid administration and allows frequent blood withdrawal for
laboratory samples.
• CVP monitoring can be done intermittently or continuously.
• Typically, a single lumen CVP line is used for intermittent pressure readings.
• For intermittent CVP monitoring: Disposable CVP manometer set leveling device (such as a
rod from a reusable CVP pole holder or a carpenter’s level or rule) additional stopcock (to
attach the CVP manometer to the catheter) extension tubing (if needed) I.V. pole I.V.
solution I.V. drip chamber and tubing dressing materials tape.
• For continuous CVP monitoring: Pressure monitoring kit with disposable pressure transducer
leveling device bedside pressure module continuous I.V. flush solution 1 unit/1 to 2 ml of
heparin flush solution pressure bag.
• For using an intermittent CV line: Syringe with normal saline solution syringe with heparin
flush solution.
• For removing a CV catheter: Sterile gloves suture removal set sterile gauze pads povidone-
iodine ointment dressing tape.
Implementation
• Align the base of the manometer with the previously determined zero reference point by using a
leveling device.
• Because CVP reflects right atrial pressure, you must align the right atrium (the zero reference
point) with the zero mark on the manometer.
• To find the right atrium, locate the fourth intercostal space at the midaxillary line.
• Mark the appropriate place on the patient’s chest so that all subsequent recordings will be
made using the same location.
• If the patient can’t tolerate a flat position, place him in semi-Fowler’s position.
• When the head of the bed is elevated, the phlebostatic axis remains constant but the midaxillary
line changes.
• Use the same degree of elevation for all subsequent measurements.
• Attach the water manometer to an I.V. pole or place it next to the patient’s chest.
• Make sure the zero reference point is level with the right atrium.
MEASURING CVP WITH A WATER
MANOMETER
• To ensure accurate central venous pressure (CVP) readings,
make sure the manometer base is aligned with the patient’s
right atrium (the zero reference point).
Manometer
Zero point
Three-way stopcock
• Verify that the water manometer is connected to the I.V. tubing.
Typically, markings on the manometer range from –2 to 38 cm H2O.
• Turn the stopcock off to the patient, and slowly fill the manometer
with I.V. solution until the fluid level is 10 to 20 cm H2O higher than
the patient’s expected CVP value.
• Don’t overfill the tube because fluid that spills over the top can
become a source of contamination.
• Turn the stopcock off to the I.V. solution and open to the patient.
• When the fluid level comes to rest, it will fluctuate slightly with respirations.
• After you’ve obtained the CVP value, turn the stopcock to resume the I.V.
infusion.
• The physician removes the dressing and exposes the insertion site.
• The physician pulls the catheter out in a slow, smooth motion and
then applies pressure to the insertion site.
• Clean the insertion site, apply povidone-iodine
ointment, and cover it with a dressing as
ordered.
• Apply ointment, and then cover the site with a sterile gauze
dressing or a clear occlusive dressing.
• Change the I.V. solution every 24 hours and the I.V. tubing
every 48 hours, according to facility policy.
• Label the I.V. solution, tubing, and dressing with the date,
time, and your initials.
Complications