Download The distal port.

__Brittany Rowe__________________
PAP/CVP/Arterial Line Monitoring
ICP Monitoring
1. Where in the heart are CVPs measured
and which port in the pulmonary artery
catheter measures CVP (distal or
proximal)?
1. What is a normal ICP?
<15mmHg
CVPs are measured in the tip of the right
atrium. The proximal port measures CVP.
2. Where can catheters to measure ICP be
placed?
2. Where in the heart are PAPs measured
and which port in the pulmonary artery
catheter measures PAP (distal or
proximal)?
Catheters can be placed in the lateral (nondominant preferred) ventricular, the
subarachnoid space, the subdural space,
the epidural space or epidural.
PAPs are measured in the pulmonary artery
with the distal port
3. At what point on the patient is the ICP
device leveled?
3. Which type of line do you need to
obtain CO and SVR readings?
A swan line.
The device should be leveled at the
foramen of Monroe (the tragus of the ear).
4. If your patient has an elevated ICP, what
can/should you do?
4. In which port in the pulmonary artery
catheter may you NOT administer
fluids?
The distal port.
For an elevated ICP the nurse should
decrease stimuli-minimal lights, limit stress,
separate out activities and allow rest in
between each. The nurse should also focus
on keeping on top of pain medication and
limiting unnecessary painful procedures.
During suctioning lidocaine should be used.
Nausea and vomiting should be controlled
with zofran, and FVO can be decreased with
Lasixs. The nurse should avoid valsalva with
stool softeners and neck, hip and knee
flexion. The patient should not be warm, so
setting the room temperature low or using
ice packs. Infection control should be
implemented, hand washing, antibiotics,
proper cleaning techniques. Sedation and
paralytics should also be considered.
5. Your arterial line show the following
reading: 136/84 (101). What does the
(101) represent?
The MAP
6. How can you trust an arterial line
reading based on what you have on the
monitor screen?
The arterial waveform should match
with the QRS on the ECG
7. What actions need to be taken at the
start of each shift to make sure that
pressure lines (PAP/CVP/ART) are
accurate?
The pressure lines need to be zeroed and
leveled to the phlebostatic axis (mid
auxillary and 4th intercostal line).
The nurse should stay with the patient for
the first 15 minutes when an adverse
reaction is most likely to occur. Then assess
vitals and signs of adverse reaction in #5.
Blood Products
5. How do you know if someone is having
a reaction to a blood product?
1. What all do you check between the
patient and the unit of blood before
giving it?
In front of patient:
Identify Pt Name, DOB, compare request
form information with that on the pt band
including, Rh, blood type, pt #, type of
transfusion, blood unit #, expiration date,
color and consistency of blood. Also, make
sure the patient has understood and signed
the consent form.
This all needs to then be done by a second
nurse.
The patient may experience, headache,
SOB/dyspnea, N/V, itching, fever, rash,
chills, wheezing, palpitations,
abdominal/chest/back pain, burning,
oozing at IV site, restlessness,
tachycardia, tachypnea, low Sa02,
respiratory distress, altered LOC,
hypotension, unexplained bleeding
2. What kind of solution do you hang
blood products with?
Normal Saline
3. What assessments need to be made
prior to giving blood products?
Vitals, patency of IV, LOC, check color and consistency of
blood (no clumps or bubbles), pt lab values
(Hgb, Hct, RBC count, platelets), and for pallor
Level of knowledge- teach about the signs
of a reaction in #5
4. How often do the assessments in #3
need to be made?
Vitals:
Pre-transfusion (less than 30 min before)
At the start of transfusion
15 minutes into transfusion
Every 30 minutes
At end of transfusion
find the leak. If no leak is found the chest tube
may be broken and should be replaced.
Chest Tubes
1. What is the purpose of a chest tube?
Chest tubes are used to rid of excess air, blood
or fluid from the thoracic cavity. Their use
helps prevent respiratory compromise. They
can be used when a pneumothorax, tension
pneumothorax, hemothorax is present. Chest
tubes can also be used after open-heart
surgery, or chest trauma.
2. What safety devices need to be at the
patient’s bedside with a chest tube?
Kelly clamps are needed in case there is an air
leak. There should also be a stopcock turned
to open for air to escape. Tape, pulse ox,
oxygen and a blood pressure cuff should also
be present. If the system breaks there should
be a cup with sterile water and a new system
available.
3. Which chamber should there be bubbling if
suction is applied?
Suction Control chamber
4. Which chambers should not have
bubbling?
The reservoir and water seal should not
bubble, but there maybe tidal movement in
the water seal.
5. If there is bubbling in a chamber where
there should not be bubbling, what should
you do? Is this ever normal?
There may be bubbling when the pt forcefully
deflates the lungs, as in coughing. However, if
there is constant bubbling it could indicate a
leak. If this happens two clamps should be
used to find the leak. Start at the patient and
move the clamps towards the chambers to
HEMODYNAMICS WORKSHEET
1. Your patient is in cardiogenic shock—what do you expect their hemodynamic readings
to be (increased or decreased)?
a.
b.
c.
d.
e.
HR- increase
BP/MAP- decreased
CO/CI- decreased
CVP/PAP- increased
SVR-increased
2. For each of the following hemodynamic abnormalities, list the drugs (by name), and/or
intervention (like fluids) that would be used to make the hemodynamic normal:
a. Decreased HR
Atropine, Dopamine (5mcg), Epinephrine, Olsoproterenol,
Increased HR
Adenosine, Digoxin,
Beta blocker- Propranolol/Atenolol
Calcium Channel - Diltiazem
b. Decreased BP
Dopamine (10mcg)
Fluids/Blood
Increased BP
ACE inhibitor- Captopril
Beta Blocker- Atenolol
Calcium Channel blocker-Diltiazem
Diuretics- Lasix
Nitroglycerin
c. Decreased CO/CIDigoxin, Dopamine, Dobutamine, Milirnone
d. Decreased CVP/PAPFluids/blood
e. Increased CVP/PAPDiuretics (Lasix), dialysis,
Venous dilators- MS, NTG, Amrinone
ACE inhibitor-Captopril
Aldosterone blockers- Aldactone
f. Decreased SVR
Epinephrine, Vasopressin, Phenylephrine
Increased SVRFluids- so SVR can stop trying to compensate for low BP and
fluids
Nipride/ NTG, treat CO (above) so SVR doesn’t have to compensate
Beta blockers- Atenolol
Calcium channel blockers- Cardizem