I&M final spring
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Does ART digital display need to read zero when checking zero reference?
No- signal interrupted for less than 1 second and not required
CDC recommends using _____ technique when inserting ART lines, and replacing catheters, transducers and flush tubing every ___ hours.
More peripheral Art lines display what 3 changes? (aorta vs femoral)
- 1) wider pulse pressure (taller)
- 2) delayed upstroke
- 3) slurred dicrotic notch
general changes in BP waveform as you move peripherally
- systolic increase
- diastolic decrease
- mean pressure decrease
- dP/dT increase
- waveform more peaked
What does HHb stand for?
What wavelengths does an O2 spectrophotometer measure?
660 and 940 nm (red and infrared)
what is the diff between Fractional SaO2 and Functional O2
- fractional accounts for all types of Hgb, regardless of carrying capacity
- Functional includes only OHbg and total Hgb
Why does carboxyhemoglobin read 90?
oxy and carboxy absorb equally at 660 nm
at SaO2 of 85% the ration of 660 to 940 nm is what?
What causes right shift of OHDC?
- RIGHT- increased H+
decerased O2 affinity and increased offloading
What causes left shift of OHDC?
- opposite of everything listed for right shift
De oxygenated Hgb shows higher amplitude with what wavelength?
Venous pulse effect?
double notch before major dip
What does a massimo SET do?
- Signal Extraction technology.
- separates noise from wanted signal
List dyes in order of descending effect on pulse ox: (most to least)
- Methylene blue
- Lymphazurine Blue
- Indocyanine Green
- Indigo Carmine
- Fluer = no fx
- my LIIF
With pulse ox reading, which placement will have a LONGER delay... Ear or Finger?
What are the measurement errors fro pulse ox:
- +/- 2
- +/- 3
- *95% data will fall within +- 4-6 w/ standard devation
What is perfusion index? (PULSE OX)
Is it relative?
- numerical value indication strength of IR signal returning from monitoring site (PULSE OX)
- yes- varies according to site of monitor/physiology
is transmission pulse accurate when used as reflectance pulse ox?
ASA standards require _____ ______ tones must be audible when using the PULSE OX.
IV infusion may cause poor function of ____ ___ due to hypothermia and edema if used on same limb.
Probe (Pulse ox) should not be on what finger during wake-up?
- may cause corneal abrasion if pt rubs eyes
two ways to confirm pulse ox placement accuracy:
- synchronous with pulse rate of ECG
Cerebral Oximetry is NIRS, what does this stand for?
Natrual Human Tissue window is ____ - ____ nm.
- Near-infrared spectrometry
- *710 and 830 are commonly used
- *short from tissue and skull, long for brain
What are the problems with cerebral oximetry?
- intra/extracranial blood dependence
- dependence on venous and arterial pressure
- - pt position
- - PaCO2, hypoxia, pH
- - cerebral edema
Ways to improve rSO2:
- mechanical (head position, cannula position)
- decrease metabolic demand (increase anesthetic, decr temp)
- increase supply (O2 delivery) (incr FiO2, cerebral blood flow, CO2, BP, hematocrit)
StO2 of ____ indicates adequate perfusion?
SvO2 is ______ ____________ _________ ____________.
How is it measured?
- mixed Venous O2 Saturation
- fiber optic pulmonary artery or venous catheter
Name the parts of PAC waveform: A, C, X, V, Y
- A- artrial contraction
- C- ventricular contraction (tricuspid protrusion0
- X- ventricular ejection (late)
- V- venous return
- Y- opening of tricuspid valve
spontaneous ventilation causes-
positive-pressure ventilation causes-
BOTH are measure at ___-__________
- reduction in intrathoracic pressure
- increase in intrathoracic pressure
CVP content kit first letters to answers:
Distal port has opening fartherst away from the ____ ____ ___________.
point of insertion
CVP cannula- with a wire OD of 0.028", what is the smallest cannula wire will fit through?
What is the distance from the RIJV insertion site (CVP) to the right atrium?
- 1- thermistor
- 2- pace port, venous infusion
- 3- balloon, 1cm back
- 4- pulmonary artery, connects with end
- 5- proximal port - 30 cm
- 6- air injection for balloon
Imp swan Ganz distances (PACEPORT):
proximal injectate port
When insering swan ganz- use an introducer that is ____ F larger than the catheter
PA catheter must be in what lung zone to get an accurate wedge pressure?
convert RU to ARU:
multiply by 80
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