Arterial Lines

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Arterial Lines:

Arterial Lines Professional Practice 2010

Indications for Arterial Lines:

Indications for Arterial Lines Any major medical or surgical condition that compromises cardiac output, tissue perfusion or fluid volume status, ie : MI – especially with: Acute failure Refractory pain Significant hypotension or hypertension Post Cardiac Surgery Need for evaluation of hemodynamic response to pharmacologic agents.

Slide 3:

System designed for continuous measurement of: Systole Diastole Mean Arterial Pressure Also allows direct access for blood draws for ABGs and/or other frequent tests.

Equipment:

Equipment Equipment: IV catheter 20 G (with or without guidewire ) Xylocaine without epinephrine 1% or 2% # 18 and # 25 needles 3 mL syringe Approved antiseptic Line insertion tray (on request of physician) or sterile gauze (2 x 2) x Normal Saline Pressure line monitoring kit (single) Transducer cable Pressure infusor device Transducer mount

Equipment:

Equipment Flush solution NS – 500 cc with/without Heparin(1U/cc) Pressure Bag – inflated to 300 mmHg Pressure tubing Transducer holder Arm board If inserting at the bedside….

Catheters:

Catheters Size of the catheter should be proportionate to the diameter of the cannulated artery. In small arteries – radial and DP – 20 g most often used. Usually inserted similar to an IV insertion . Large arteries – femoral or axillary – 19-20g – longer catheter.

Insertion:

Insertion Most frequent insertion site = radial Can also use femoral, DP, brachial, axillary. Allen’s Test Assessment of collateral circulation a MUST when using the radial artery.

Slide 9:

Allens test

Calibration of Equipment:

Calibration of Equipment To ensure accuracy of readings. Calibration of the system to atmospheric pressure = “zeroing” the transducer. Performed Q4h. Determine the phlebostatic axis for transducer height placement = “leveling” the transducer.

Zeroing:

Zeroing To ensure accuracy of readings Off to patient but open to atmosphere and flush device These exert pressure on transducer This pressure is called zero Zero once per shift or if values are questionable Tip-ensure flush bag is pumped up

HOB can be up to 60 degrees without effect :

HOB can be up to 60 degrees without effect

Hemodynamic Parameters:

Hemodynamic Parameters Arterial Blood Pressure (BP) Pressure exerted on arterial wall Determined by flow & resistance BP=SV X HR X SVR MAP more accurately indicates perfusion MAP = (SBP –DBP)/3 + DBP

Cont’d :

Cont’d Systolic arterial pressure = max pressure with which blood is ejected from the LV. Diastolic pressure reflects rapidity of flow through the system and the vessel’s elasticity. MAP most often used to assess perfusion. Represents perfusion pressure throughout the cardiac cycle.

Slide 15:

. Need a minimum MAP of 60 mm Hg to perfuse vital organs. Requirements will depend upon Dx . May need 90 – 110 to increase CPP in carotid or neurologic surgery. 70 – 90 may be ideal for the cardiac patient to decrease LV workload.

Normal Pressures:

Normal Pressures Systolic – 90-140 mm Hg Diastolic – 60-90 mm Hg MAP – 70 – 105 mmHg

Normal Waveform:

Normal Waveform

Causes of Abnormal Pressures:

Causes of Abnormal Pressures Increased Increased SVR HTN SNS Innervation Decreased Decreased SVR Sepsis Anaphylaxis;axis Decreased CO MI Tachydysrhythmias

Wave Form analysis:

Wave Form analysis Notches – Dicrotic notch •Closing of the aortic valve – Anacroticnotch •Severe aortic stenosis

Slide 21:

Over-Damped Waveform 􀂄 Overdamped –blunted response -indistinct waveform •Air bubbles •Position/kinking –Under estimate SBP, over estimate DBP

Slide 22:

Under-Damped Waveform 􀂄 Underdamped –exaggerated response -spiking –Over estimate SBP, under estimate DBP produces false values on the monitor .

Arterial vs Cuff Pressures:

Arterial vs Cuff Pressures Arterial catheters = direct measurement and are more accurate esp in shock, severe hypotension, vasoconstriction and obesity. Radial catheters will usually show a pressure slightly higher ( about 10 mmHg) than cuff . Map tend to be the same and are a better reflection of perfusion pressure.

Nursing Care:

Nursing Care What do you think are the Key issues for the nursing care of a patient with an arterial catheter? 5 minutes to discuss

Nursing Care #2:

Nursing Care #2 Nursing care mainly directed to preventing complications Ensure that the insertion site is visible at all times –This may not be possible with femoral-sited arterial lines –To ensure early detection of disconnection or leaking from site. –To maintain patients dignity

Slide 26:

Never inject anything into an arterial cannula or arterial line

Nursing Care# 4:

Nursing Care# 4 Ensure that the flush bag has adequate fluid. Use only 0.9% sodium chloride Ensure that the pressure in the pressure bag is maintained at 300mmHg Do not allow the flush bag to empty –To maintain patency of arterial cannula . –To prevent air embolism –To maintain accuracy of blood pressure reading –To maintain accuracy of fluid balance chart –To prevent backflow of blood

Nursing Care #5:

Nursing Care #5 Use only the manometer tubing supplied with the transducer set –Tubing is rigid and non compliant & correct length Observe for & remove air bubbles –To ensure accuracy in measuring blood pressure. Air unlike fluid is compressible as a result the pressure waveform will be dampened

Nursing Care #6:

Nursing Care #6 Monitor colour & temperature of limb distal to arterial line & compare to other limb –To confirm that circulation to the limb is adequate. –To ensure the early detection of impaired circulation

Nursing Care # 7:

Nursing Care # 7 On removal of arterial cannula maintain pressure over puncture site for at least 5 minutes until bleeding has stopped –To prevent bleeding and hematoma formation Send cannula tip to microbiology –Only if suspected infection