Chapter 10 Blood Gas

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Chapter 10 Blood Gas
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2012-02-06 10:30:04
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Blood gas
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It is about blood gas in neonates
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  1. 17. HOW OFTEN WILL YOU DRAW
    BLOOD TODAY? How long
    will you wait for the results?

    Critically ill patients: premature infants with severe cardiopulmonary disease, pts with acute respiratory distress syndrome, sepsis, severe trauma

    Hypovolemia: decreased blood volume; more specifically, decrease in volume of blood plasma.[The patient may feel dizzy, faint, nauseated, or very thirsty.
  2. 18. Using a closed-loop system,
    • the VIA LVM gently and automatically
    • draws just 1.5 cc of blood into a special sensor where
    • it’s analyzed for about a minute. Monitor is place directly in line with arterial or umbilical catheter. Then the blood is
    • automatically reinfused to the baby. Keeping the blood
    • where it should be – in your patient. It samples and provides results every 11 minutes if necessary, visually displays them on the monitor, and prints a hard copy for the patient record.Self-Calibration
    • Initial 2-point calibration. Self-calibration after
    • each sample and at least every 30 minutes
    • 1.Cal solution
    • 2.Via in line monitor and printer
    • 3.Collection bag
    • 4.Infusion set
    • 5.SensorCardiac and hemodyamic mon
  3. 18. Using a closed-loop system,
    the VIA LVM gently and automatically
    draws just 1.5 cc of blood into a special sensor where
    it’s analyzed for about a minute. Monitor is place directly in line with arterial or umbilical catheter. Then the blood is
    automatically reinfused to the baby. Keeping the blood
    where it should be – in your patient. It samples and provides results every 11 minutes if necessary, visually displays them on the monitor, and prints a hard copy for the patient record.Self-Calibration
    Initial 2-point calibration. Self-calibration after
    each sample and at least every 30 minutes
    1.Cal solution
    2.Via in line monitor and printer
    3.Collection bag
    4.Infusion set
    5.SensorCardiac and hemodyamic mon
  4. With no syringes or stopcocks, you reduce the chance
    of infection to your patient
    eliminating blood
    exposure means less risk to healthcare
    Workers
    Measures pH, pCO2 , pO2 , Sodium,
    Potassium and Hematocrit.
    Calculates Hemoglobin,
    Bicarbonate, Base
    Excess, Total CO2 , and
    O2 Saturation.

    Before Neotrend came on the market a baby’s blood gases were measured by taking a 0.1ml sample of blood and
    measuring the level of the gases. This process could take up to 5 hours by which time the
    baby’s health could have been damaged permanently. A premature baby can have as little
    as 50ml of blood in their tiny body and in some cases up to 20 samples of blood need to be
    taken in one day!
    A decrease in the amount of blood in circulation makes
    it more difficult for the baby to survive.
  5. 20. The sensor itself is just 25mm
    long, or about the length of a small
    paper clip. Its diameter is only 0.5mm,
    the equivalent of just 10 human hairs
  6. Probe in femoral artery give more reliable result than radial artery for it is susceptible to motion, changes in peripheral blood flow. Other sites are peripheral veins in children and jugular venous bulb in adults.

    Low blood flow or no blood flow (resuscitation) make inaccurate result

    21.The sensor itself is just 25mm
    long, or about the length of a small
    paper clip. Its diameter is only 0.5mm,
    the equivalent of just 10 human hairs. Attached to wall, combine blood and tissue PO2
  7. A central venous catheter is a long, soft plastic tube (usually made of silicone) that is placed via a small cut in the neck, chest, or groin into a large vein in the chest to allow IV fluids and medications to be given over an extended period of time.

    Is placed in venous sys so the distal tip of catheter will go into right atrium. Pressure between the vena cava = pressure in atrium for there is no heart valve
    Pic: subclavian vein
  8. 23. Administration parental nutrition to a chronically ill child
    Fluids administration to central circulation, when a large volume of fluid is needed that cannot infuse it by using the peripheral intravenous catheter
    During diastole, tricuspid valve opens, RV andRL filled, P in RV=P in vena cava

    Sepsis: the presence of bacteria and their toxins, typically through an infection of a wound if the catheter is placed longer than 72 hours.
    In neonatal, fungal sepsis is major. In children, pulmonary embolism. Obstruction of pulmonary arteries, caused by fragment of a clot from a leg or pelvic vein

    Dysrhythmias if cathater slip to right ventricle instead of RA

    Trhombosis occurs mostly with femoral vein. Blood clot in blood vessel or chamber of heart

    Air embolus: during insert procedure and when tube is disconnected. Bubble of air in heart or vascular sys causes obstruction
  9. Can inserted with femoral vein
    Sample from RA may be mixed venous blood so pulmonary catheter is the gold standard to obtain the mixed venous blood.
    The reason we get MVB is to measure the SvO2 and PO2 in veins and then compare to the arterial sampling, gives us an overall tissue oxygenation
  10. 25.
    Four types of CVC:
    Non-tunneled : short term therapy , 6-8 inch, frequent change, highest infection risk, but easy to insert, remove and replace. a small flexible plastic tube

    Tunneled: long term, surgically inserted into a vein in the neck or chest and passed under the skin. Only the end of the catheter is brought through the skin through which medicines can be given. Passing the catheter under the skin helps keep it in place better, lets you move around easier, and makes it less visible. Passing the catheter under the skin helps to prevent infection and provides stability.

    Peripherally inserted: is a central venous catheter inserted into a vein in the arm rather than a vein in the neck or chest.
    Implantable ports: similar to a tunneled catheter but is left entirely under the skin
  11. 27. A wave: atrial contraction, height depends how much pressure RA use to pump blood to RV. P wave
    C wave: closure of tricuspid valve at the beginning of ventricular contraction, elevate a bit in RA. End of QRS segment
    X wave: atrium relaxes, P in atrium and CVP falls
    V wave: atrium is filled with blood, P gonna increase for heart muscle is stretched , P goes peak. Before T wave
    Y wave: tricuspid valve opens, ventricle filled , CVP falls. Before P wave

    Always measure CVP during a resting exhalation for in inspiration, CVP falls because of the intrathoracic pressure decreases so air can flow in
    Positive pressure: can elevate CVP
    Decreased CVP can be caused by fluid imbalance, hemorrhage, extreme vasodilation and shock
  12. It is used less often in peDIATRICS.
  13. 31. Blood flow will carry the catheter into the pulmonary artery until the diameter of the artery diminishes that the catheter get stuck, we call the catheter is wedged
  14. 32. Overflation the balloon results rupture in pulmonary artery, obstruction
    Pulmonary infarction: catheter is left in wedged position for too long
  15. Cardiac out put is the amount of blood is pumped from the heart to the system in 1 min.
    34. At birth, CO is about 0.6 L/min and increase to 5 or 6 L/min in adults
    Measure by thermodilution technique. Inject the liquid, it mixes with the blood and passes through right ventricle into pulmonary artery , the thermistor measure the rate of change on blood temperature.
  16. 35.
    Non invasive reduce the number of ABG drawn in acute care setting but ABGs is still the standard
    is more comfortable for patients and eliminate less risk of infection in pts and other complications like hemotoma
  17. 36.
    Spo2: measure the oxygen sat in arterial blood. The red light passes through the capillary bed and measure the sat of oxygen in capillary bed. It depends on the hemoglobin saturation (sat Hgb is red and desat is darker) so the oximeter base on the color to measure the oxygen sat. It is used as continuous nonivasive measurements of peripheral perfusion.
  18. 37.
    The TCO2M Transcutaneous Monitor is the latest in transcutaneous CO2 and O2 monitoring technology from Novametrix. This lightweight, portable monitor with its easy-to-see display and rugged, reliable sensors, is ideal for use in the NICU, PICU, vascular lab, hyperbaric medicine, wound care, or sleep lab; wherever it is important to provide accurate continuous measurement of transcutaneous CO2 and O2.

    End tidal CO2 Monitor are used to assess the partial pressure of CO2 in exhaled gas (PetCO2). Used in anesthesia setting and critical setting

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