AHN 447 EXAM 1 QUESTIONS AND ANSWERS
Common invasive hemodynamic monitoring techniques - Answers - 1) Central LIne
(CVP)
2) Arterial LIne
3) PA Catheter (swanganz catheter)
Information that can be obtained from SwanGanz (PA) catheter? - Answers - 1) CVP
2) PAP
3) SVO2
4) PCWP
5) SVR
6) CI
7) CO
8) Temp
Role of transducer in hemodynamic monitoring? - Answers - converts pressures into
electrical signal; MUST BE USED W/ HEMODYNAMIC TUBING
Where is the transducer kept? - Answers - 4th ICS midaxillary line! If too low,
pressures will read too high; if too high, pressures will read too low
What is the role of the amplifier/monitor of the hemodynamic system? - Answers -
produces wave form (readable measures of pressure)
provides continuous measures of pressure
role of 3-way stop cocks in hemodynamic system? - Answers - ports used to draw labs
or ABG's
Difference between use of 3W stop cocks in central lines v. arterial lines? - Answers -
CL: labs, med administration
AL: labs, ABG's; NOTHING ADMINISTERED VIA AL, ONLY NS to FLUSH
role of flush system in hemodynamic monitoring? - Answers - this is a pigtail on the
end of the transducer; role is to pull NS from fluid bad through the system; way of
"priming" the tubing
When should the flush system be pulled? - Answers - BEFORE CONNECTING TO
PATIENT!! Risk: AIR EMBOLISM
Components of pressure system? - Answers - 1) 500 mL NS bag (w/ or w/o heparin to
prevent clotting of site)
2) pressure bag
NS bag placed in pressure bag and pumped to 300 mmHg (until green marker pops up
on pressure bag)
**This ensures an infusion rate of 3 mL/hr of NS to keep access patent
,How do we zero out a hemodynamic monitoring system? - Answers - Open the
stopcock at the level of the transducer and zero out the system on the computer
**This is done once per shift
What are the 3 sites of ALine insertion? - Answers - 1) Radial - first choice
2) Brachial - limits mvmt
3) Femoral - last resort; increased chance of infection
What assessment must be performed prior to an ALine insertion? - Answers - Allen's
Test
1) occlude R and U arteries
2) pump fist upright 30 seconds until pallor
3) release U artery
4) hand should perfuse w/in 15-30 seconds MAX
What are the components of an ALine waveform? - Answers - 1) Peak = systolic
pressure
2) Wave = diastolic pressure
3) Dicrotic notch = represents closure of aortic valves
**BE ABLE TO SPOT THE DIFFERENCE IN A NORMAL V. DAMPENED WAVE FORM
- Answers - normal waves should have a peak and a valley; should NOT look like
"humps" or "mountains"
MAP calculation (minimum 60 to perfuse vital organs) - Answers - SBP + (2x DBP)/3
NSg Care for an ALine - Answers - 1) assess site QH
2) assess circulation of extremity
3) dsg - sterile transparent
4) Assess restraints QH if applicable
5) obtain informed consent
6) NV CHECKS
What can be used to hyperflex the hand with an ALine? - Answers - wrist splint (NOT
A RESTRAINT)
What should you do first if you question the accuracy of your monitor? - Answers -
obtain a manual cuff reading
What is included in an NV assessment? - Answers - 5 P's
1) Pallor
2) Paresthesia
3) Pain
4) Paralysis
5) pulselessness
, Complications of ALines? - Answers - 1) Infection
2) Arteriospasm
3) nerve damage
4) bleeding/hemorrhage/hematoma
5) Clots
6) NV issues
Functions of PA (SG) Catheter? - Answers - 1) measures pressures in R/L side of the
heart and the great vessels
2) Measures core temp w/in the heart
3) Measures CO
What are the ports of the SwanGanz Cath? - Answers - 1) Proximal Port - measures
CVP
2) Distal Port - measures PAP
3) Thermistor Port - connects to monitor
4) VIP Port - meds
5) Balloon port - connects 1.5 mL syringe for balloon
Route of Insertion of PAC? - Answers - 1) L subclavian
2) SVC
3) RA
4) Tricuspid valve
4) RV
5) pulmonary artery
Insertion sites of a PAC? - Answers - 1) R/L subclavian
2) R/L jugular vein
What is the purpose of the Cordis introducer? - Answers - large central line inserted
prior to PAC insertion to help guide the catheter
Nsg Actions during PAC insertion? - Answers - 1) informed consent
2) record pressures during insertion
3) monitor for dysrhythmias during insertion (RV)
4) CXR after placement
5) set up hemodynamic system before insertion
**MEMORIZE DIAGRAM OF PAC WAVEFORMS AT 28:30 - Answers -
How to record PAWP pressures in a patient w/ PAC? - Answers - inflate the balloon,
pressures will change to PAWP, deflate the balloon, and pressures should return to
PAP
Common invasive hemodynamic monitoring techniques - Answers - 1) Central LIne
(CVP)
2) Arterial LIne
3) PA Catheter (swanganz catheter)
Information that can be obtained from SwanGanz (PA) catheter? - Answers - 1) CVP
2) PAP
3) SVO2
4) PCWP
5) SVR
6) CI
7) CO
8) Temp
Role of transducer in hemodynamic monitoring? - Answers - converts pressures into
electrical signal; MUST BE USED W/ HEMODYNAMIC TUBING
Where is the transducer kept? - Answers - 4th ICS midaxillary line! If too low,
pressures will read too high; if too high, pressures will read too low
What is the role of the amplifier/monitor of the hemodynamic system? - Answers -
produces wave form (readable measures of pressure)
provides continuous measures of pressure
role of 3-way stop cocks in hemodynamic system? - Answers - ports used to draw labs
or ABG's
Difference between use of 3W stop cocks in central lines v. arterial lines? - Answers -
CL: labs, med administration
AL: labs, ABG's; NOTHING ADMINISTERED VIA AL, ONLY NS to FLUSH
role of flush system in hemodynamic monitoring? - Answers - this is a pigtail on the
end of the transducer; role is to pull NS from fluid bad through the system; way of
"priming" the tubing
When should the flush system be pulled? - Answers - BEFORE CONNECTING TO
PATIENT!! Risk: AIR EMBOLISM
Components of pressure system? - Answers - 1) 500 mL NS bag (w/ or w/o heparin to
prevent clotting of site)
2) pressure bag
NS bag placed in pressure bag and pumped to 300 mmHg (until green marker pops up
on pressure bag)
**This ensures an infusion rate of 3 mL/hr of NS to keep access patent
,How do we zero out a hemodynamic monitoring system? - Answers - Open the
stopcock at the level of the transducer and zero out the system on the computer
**This is done once per shift
What are the 3 sites of ALine insertion? - Answers - 1) Radial - first choice
2) Brachial - limits mvmt
3) Femoral - last resort; increased chance of infection
What assessment must be performed prior to an ALine insertion? - Answers - Allen's
Test
1) occlude R and U arteries
2) pump fist upright 30 seconds until pallor
3) release U artery
4) hand should perfuse w/in 15-30 seconds MAX
What are the components of an ALine waveform? - Answers - 1) Peak = systolic
pressure
2) Wave = diastolic pressure
3) Dicrotic notch = represents closure of aortic valves
**BE ABLE TO SPOT THE DIFFERENCE IN A NORMAL V. DAMPENED WAVE FORM
- Answers - normal waves should have a peak and a valley; should NOT look like
"humps" or "mountains"
MAP calculation (minimum 60 to perfuse vital organs) - Answers - SBP + (2x DBP)/3
NSg Care for an ALine - Answers - 1) assess site QH
2) assess circulation of extremity
3) dsg - sterile transparent
4) Assess restraints QH if applicable
5) obtain informed consent
6) NV CHECKS
What can be used to hyperflex the hand with an ALine? - Answers - wrist splint (NOT
A RESTRAINT)
What should you do first if you question the accuracy of your monitor? - Answers -
obtain a manual cuff reading
What is included in an NV assessment? - Answers - 5 P's
1) Pallor
2) Paresthesia
3) Pain
4) Paralysis
5) pulselessness
, Complications of ALines? - Answers - 1) Infection
2) Arteriospasm
3) nerve damage
4) bleeding/hemorrhage/hematoma
5) Clots
6) NV issues
Functions of PA (SG) Catheter? - Answers - 1) measures pressures in R/L side of the
heart and the great vessels
2) Measures core temp w/in the heart
3) Measures CO
What are the ports of the SwanGanz Cath? - Answers - 1) Proximal Port - measures
CVP
2) Distal Port - measures PAP
3) Thermistor Port - connects to monitor
4) VIP Port - meds
5) Balloon port - connects 1.5 mL syringe for balloon
Route of Insertion of PAC? - Answers - 1) L subclavian
2) SVC
3) RA
4) Tricuspid valve
4) RV
5) pulmonary artery
Insertion sites of a PAC? - Answers - 1) R/L subclavian
2) R/L jugular vein
What is the purpose of the Cordis introducer? - Answers - large central line inserted
prior to PAC insertion to help guide the catheter
Nsg Actions during PAC insertion? - Answers - 1) informed consent
2) record pressures during insertion
3) monitor for dysrhythmias during insertion (RV)
4) CXR after placement
5) set up hemodynamic system before insertion
**MEMORIZE DIAGRAM OF PAC WAVEFORMS AT 28:30 - Answers -
How to record PAWP pressures in a patient w/ PAC? - Answers - inflate the balloon,
pressures will change to PAWP, deflate the balloon, and pressures should return to
PAP
