NUR 211 Perfusion Questions with Correct
Answers
What is hemodynamics?
This is the physical principles of blood flow based on pressure and resistance throughout our
circulatory system.
List the pathway of blood through the heart
IVC + SVC ---> RA --> Tricuspid --> RV --> Pulmonic valve --> Pulmonary artery --
>Lungs-->Pulmonary Veins --> LA --> Bicuspid (Also known as Mitral) --> LV --> Aortic
Valve--> Aorta
What is mean arterial pressure?
pressure forcing blood into tissues, averaged over cardiac cycle
What are the normal ranges of map?
About 65-110
What does a patient's MAP within normal ranges tell you?
That the patient's body is perfusing correctly. However you still need to assess your patient.
How do you calculate MAP?
(SBP + 2DBP)/3
Talk about what we would see with mitral valve stenosis.
We will see problems with the left side of the heart. It would affect both the atrium and
ventricle (as it's located between both of these structures). Then we will see blood start
,backing up and then fluid would back up into the lungs. We would hear crackles in the lungs.
If you understand the blood flow of the heart it will help you remember this.
What is the phlebostatic axis?
It is the reference point on the chest that is used as a baseline for consistent tranducer height
placement. It is the 4th intercostal point and midaxillary line. It's lined up with the left atrium.
What is an arterial line?
Catheter that is inserted into an artery. Device used to measure an accurate blood pressure
and get lab draws in a patient.
What is important to remember regarding the transducer and the patient?
The transducer needs to be at the same level as the phlebostatic axis (left atrium)
How do we ensure that the phlebostatic axis is level with the transducer?
A level or measure the height. Don't eyeball it.
How often do we zero out an arterial line?
At least twice a shift
What is the function of a pressure bag?
They apply pressure to a fluid and can help push fluid quickly to a patient. It also helps
maintain constant pressure of the arterial line. This is important so blood won't back into the
arterial line. It provides pressure in order provide a number for our blood pressure. It's
typically filled with NS (used to be heparin, but people started getting killed from accidents).
What pressure is a pressure bag typically set to?
300 mmHg; or if the bag indicates it is properly pressurized (green)
,What rate does a pressure bag for an arterial line provide fluid at for a patient?
About 3 mL an hour; not enough to hydrate a patient or anything
What are the two most popular places to place an arterial line?
The radial and femoral arteries
What place is preferred to place an arterial line over the 2 we mentioned in class and
why?
Radial; femoral is in a location that is more prone to infection because of not being clean.
When priming the tube for an arterial line, we know it's similar to an IV but with one
difference. What is it?
We want the tube to be completely full, we don't do it halfway like we would with an IV. We
want zero air in that line.
What does the top part of an arterial wave form mean? The bottom part?
Top is systolic and bottom is diastolic bp
What can cause discrepancies in arterial wave forms?
If there is too much tubing, air in the line, incorrect pressurization of bag, or a kink in the
arterial line.
What else can we do with an arterial line aside from get a blood pressure?
We can draw arterial blood; so we can get some lab values without increasing the risk of
infection with a patient with multiple sticks.
What are some complications of an arterial line?
, Bleeding, infection, lack of blood flow to tissues, air embolism (same considerations as an
IV)
What kind of medications are allowed to be pushed through an arterial line?
No meds can ever be given in an arterial line, can kill the patient.
What is the risk of insertion of an arterial line?
We mentioned earlier perfusion of tissue. We can damage our artery to a point where it no
longer perfuses an extremity and can result in necrosis.
What does Allen's test test for?
Check's for alternative circulation
Checks to make sure the ulnar artery is sufficient enough to provide hand circulation if the
radial artery is occluded.
How do we perform an Allen's test?
Occlude both the radial and ulnar arteries. Your hand should start changing color. Now
release your ulnar artery. If your hand returns to its normal skin color you have a good
functioning ulnar artery. Remember, we use the radial for an arterial line. If we damage the
radial and we already have a bad ulnar artery, the patient can lose their hand.
How long do you apply pressure to an artery if an arterial line is removed?
Until it stops bleeding
What is information we would provide to a doctor if an arterial line is removed?
The hemodynamic stability of our patient. The patient may or may not need it reinserted. We
have to think of a few things: are they hemodynamically stable now? Are they
Answers
What is hemodynamics?
This is the physical principles of blood flow based on pressure and resistance throughout our
circulatory system.
List the pathway of blood through the heart
IVC + SVC ---> RA --> Tricuspid --> RV --> Pulmonic valve --> Pulmonary artery --
>Lungs-->Pulmonary Veins --> LA --> Bicuspid (Also known as Mitral) --> LV --> Aortic
Valve--> Aorta
What is mean arterial pressure?
pressure forcing blood into tissues, averaged over cardiac cycle
What are the normal ranges of map?
About 65-110
What does a patient's MAP within normal ranges tell you?
That the patient's body is perfusing correctly. However you still need to assess your patient.
How do you calculate MAP?
(SBP + 2DBP)/3
Talk about what we would see with mitral valve stenosis.
We will see problems with the left side of the heart. It would affect both the atrium and
ventricle (as it's located between both of these structures). Then we will see blood start
,backing up and then fluid would back up into the lungs. We would hear crackles in the lungs.
If you understand the blood flow of the heart it will help you remember this.
What is the phlebostatic axis?
It is the reference point on the chest that is used as a baseline for consistent tranducer height
placement. It is the 4th intercostal point and midaxillary line. It's lined up with the left atrium.
What is an arterial line?
Catheter that is inserted into an artery. Device used to measure an accurate blood pressure
and get lab draws in a patient.
What is important to remember regarding the transducer and the patient?
The transducer needs to be at the same level as the phlebostatic axis (left atrium)
How do we ensure that the phlebostatic axis is level with the transducer?
A level or measure the height. Don't eyeball it.
How often do we zero out an arterial line?
At least twice a shift
What is the function of a pressure bag?
They apply pressure to a fluid and can help push fluid quickly to a patient. It also helps
maintain constant pressure of the arterial line. This is important so blood won't back into the
arterial line. It provides pressure in order provide a number for our blood pressure. It's
typically filled with NS (used to be heparin, but people started getting killed from accidents).
What pressure is a pressure bag typically set to?
300 mmHg; or if the bag indicates it is properly pressurized (green)
,What rate does a pressure bag for an arterial line provide fluid at for a patient?
About 3 mL an hour; not enough to hydrate a patient or anything
What are the two most popular places to place an arterial line?
The radial and femoral arteries
What place is preferred to place an arterial line over the 2 we mentioned in class and
why?
Radial; femoral is in a location that is more prone to infection because of not being clean.
When priming the tube for an arterial line, we know it's similar to an IV but with one
difference. What is it?
We want the tube to be completely full, we don't do it halfway like we would with an IV. We
want zero air in that line.
What does the top part of an arterial wave form mean? The bottom part?
Top is systolic and bottom is diastolic bp
What can cause discrepancies in arterial wave forms?
If there is too much tubing, air in the line, incorrect pressurization of bag, or a kink in the
arterial line.
What else can we do with an arterial line aside from get a blood pressure?
We can draw arterial blood; so we can get some lab values without increasing the risk of
infection with a patient with multiple sticks.
What are some complications of an arterial line?
, Bleeding, infection, lack of blood flow to tissues, air embolism (same considerations as an
IV)
What kind of medications are allowed to be pushed through an arterial line?
No meds can ever be given in an arterial line, can kill the patient.
What is the risk of insertion of an arterial line?
We mentioned earlier perfusion of tissue. We can damage our artery to a point where it no
longer perfuses an extremity and can result in necrosis.
What does Allen's test test for?
Check's for alternative circulation
Checks to make sure the ulnar artery is sufficient enough to provide hand circulation if the
radial artery is occluded.
How do we perform an Allen's test?
Occlude both the radial and ulnar arteries. Your hand should start changing color. Now
release your ulnar artery. If your hand returns to its normal skin color you have a good
functioning ulnar artery. Remember, we use the radial for an arterial line. If we damage the
radial and we already have a bad ulnar artery, the patient can lose their hand.
How long do you apply pressure to an artery if an arterial line is removed?
Until it stops bleeding
What is information we would provide to a doctor if an arterial line is removed?
The hemodynamic stability of our patient. The patient may or may not need it reinserted. We
have to think of a few things: are they hemodynamically stable now? Are they
