ECCO: Hemodynamic Monitoring Critically Ill Patients: Part 1 2019
A patient has an arterial line connected to a hemodynamic monitoring system. Which of these should the nurse verify to ensure accurate readings will be obtained?
Transducer is placed at 4th ICS midpoint of the anterior/posterior chest diameter.
How can a nurse prevent the most common complication that occurs with CVCs?
Select all that apply - Check RR and SpO2 frequently - Change IV tubing and dresing per guidelines - Before accessing a port, "scrub the hub" for 15-30 seconds - Obtain chest x-ray following insertion.
In caring for a patient with a CVC, you note a waveform suddenly disappears from the monitor. The value was 11 mm Hg and now reads 0 mm Hg. What intervention should you initially anticipate?
- Set up a new pressure tubing, flush, and re-zero _ Administer a hypertonic fluid bolus followed by a diuretic Correct - Assess patient; assess catheter and pressure tubing for kinks or turned stopcocks -
Immediately following a lab draw from a patient's right subclavian CVC, the patient develops shortness of breath. What condition should the nurse suspect?
- Vascular erosion - Hemothorax - Migration of catheter tip Correct - Air embolus
On the CVP waveform of a patient with atrial flutter, the wave may be missing or there may be many a waves. Measure the CVP pressure on the waveform shown.
19 mm Hg
A patient with pulmonary hypertension is admitted. Which of the following CVP readings should the nurse anticipate?
22 mm Hg
Interpret the CVP from the tracing shown.
9 mm Hg Rational: Formula is: = (Average low + Average high) / 2 - In the picture it looks like (5+ 13) / 2 = 9
Which of the following should the nurse include when caring for a patient with a CVC?
?
A nurse suspects a pneumothorax in a patient following insertion of a CVC. What should be the nurse's priorities?
?Notify the provider; Request a chest x-ray; Ask provider to reposition catheter.
After a subclavian CVC is inserted and dressed, what should be the nurse's next step?
Request order for chest x-ray to confirm catheter tip is properly placed and lung is intact.
After removing an arterial catheter from a femoral site, how long should you apply pressure above and over the site to reach hemostasis?
About 20 minutes
During insertion of a CVC, a nurse observes a minor break in aseptic technique. What step, if any, should the nurse take?
Announce the break immediately.
Which of the following steps should the nurse include when removing a radial artery catheter?
Correct - Apply pressure two finger widths above the insertion site? x - Hold pressure on site for 20 minutes x - Shut off the flush system 15 minutes prior to starting procedure x - Cover site with a bandage after catheter is removed
What should the nurse be ready to do upon seeing backflow of blood into the radial artery catheter upon insertion ?
Correct - Connect pressure monitoring tubing immediately - Turn stopcock - Clamp Pressure - Check monitoring
A nurse observes blood oozing from a radial catheter site, exposes the area to view, and asks a team member to notify the provider. What other steps should the nurse take?
Correct - Don sterile gloves, and apply pressure over site; Correct - If directed, apply absorbable gelatin sponge; Correct - Reinforce dressings at site.
Ten minutes after a CVC is removed, the patient reports difficulty breathing and chest pain. BP before removal; 126/70 (89); now: 80/40 (53). Patient is slightly cyanotic. Bedsides notifying the provider, what is initially indicated?
Correct - Place patient in lateral decubitus and trenelenburg
A patient with a femoral artery catheter reports worsening back pain. The nurse notes new onset tachycardia and slight decrease in BP. What development should the nurse suspect?
Retroperitoneal bleeding
What is the main purpose of quickly activating and releasing the flush device to bounce the waveform into a "square wave?"
To evaluate the dynamic response of the system.
A patient with a radial arterial catheter has a damped waveform. The nurse is unable to aspirate blood from the line and notes pallor of the affected hand but no cyanosis. The nurse should:
Notify provider, and prepare to remove the catheter.
The result of an Allen's test on the nondominant hand is 16 seconds. What is the nurse's next step?
Notify provider, and test dominant hand.
Interpret the result of the square wave test shown.
Optimally damped
What patient conditions should the nurse consider upon seeing this arterial pressure waveform?
Pericardial effusion; Constrictive pericarditis; Cardiac tamponade.
A CVC was inserted in the right subclavian vein of a patient who is now restless and short of breath, with decreasing SpO2, tachypnea, and diminished breath sounds on the right side. For what should the nurse be prepared to intervene?
Pneumothorax
What patient conditions should the nurse consider based upon this central venous waveform?
Pulmonary hypertension; Right ventricular failure; COPD.
