Post on 26-Oct-2014
description
ARTERIAL LINE & CENTRAL LINE
ARTERIAL LINE
What is an arterial line? An arterial line is a cannula usually
positioned in a peripheral artery such as Radial a. Dorsalis pedis a. Brachial a. Femeral a.
INDICATIONS FOR USING ARTERIAL LINE
Continuous monitoring of arterial blood pressure if patient is on
inotropic drugs if patient is on
vasoactive drug if patient requires
frequent arterial blood sampling
COMPLICATIONS ASSOCIATED WITH ARTERIAL LINES
HYPOVOLEMIA ACCIDENTAL INTRA-ARTERIAL
INJECTION OF DRUGS LOCAL DAMAGE TO ARTERY
THE ARTERIAL WAVEFORM
The arterial waveform reflects the pressure generated in the arteries following ventricular contraction and can be described as having:- Dicrotic notch Peak systolic
pressure Diastolic pressure
Arterial line tracing
Dampened: wide,flattened tracing Dampenning occcurs due to:
Air bubbles Over distensible tubing Catheter kinks Clot Low flush bag pressure
UNDERESTIMATE blood pressure
Resonant: spiked tracing
Due to Long, stiff ,non-complaint tubing Increase vascular resistance Non fully opened stopcock valve
OVERESTIMATE blood pressure If doubt: NIBP
Calibrate and balance transducer every 8h
เปรี�ยบเที�ยบกับ NIBP Flush สายด้ วย heparin ที�กั 1h สงเกัต อากัารีผิ�ด้ปกัต�เช่�น เลื�อด้ออกั อ�ณหภู�มิ�
สายหกั พับ งอ หลื�ด้
REMOVAL OF ARTERIAL LINE
THIS IS AN ASEPTIC PROCEDURE REMEMBER UNIVERSAL PRECAUTIONS THE PROCEDURE SHOULD BE EXPLAINED TO
THE PATIENT TAKE DRESSING OFF LINE REMOVE ARTERIAL LINE ENSURING THAT THE
ENTRY SITE IS COVERED WITH GAUZE APPLY DIGITAL PRESSURE FOR AT LEAST 5
MINUTES TO ENSURE HAEMOSTASIS DRESS SITE WITH GAUZE AND MICROPORE ASSESS THE PERIPHERAL CIRCULATION AS
THROMBOSIS CAN OCCUR AFTER REMOVAL
CENTRAL VENOUS PRESSURECVP
WHAT IS A CENTRAL LINE
It is a catheter that provides venous access via the superior vena cava or right atrium
COMMON CENTRAL LINE INSERTION SITES
Right internal jugular
left internal jugular right subclavian left subclavian femoral (as a last
resort)
Or peripherally inserted central catheters (PICC) which are inserted via the antecubital veins (basilic vein is the best) in the arm and is advanced into the central veins
TYPES OF CENTRAL LINE
SINGLE LUMEN Multilumen
CENTRAL LINES
Indications for CVP lines are:- fluid resuscitation Parenteral feeding measurement of central venous pressure poor venous access administration of irritant drugs
COMPLICATIONS FOLLOWING CVP LINE INSERTION
Malposition of the catheter
haematoma arterial puncture pneumothorax haemorrhage sepsis air emboli
Catheter embolism Thrombosis Haemothorax Cardiac
tamponade Cardiac
arrhythmias
CVP READINGS ARE USED:-
TO SERVE AS A GUIDE TO FLUID BALANCE IN CRITICALLY ILL PATIENTS
TO ESTIMATE THE CIRCULATING BLOOD VOLUME
TO ASSIST IN MONITORING CIRCULATORY FAILURE
CENTRAL VENOUS PRESSURE MONITORING
THIS IS A HELPFUL TOOL IN THE ASSESSMENT OF CARDIAC FUNCTION, CIRCULATING BLOOD VOLUME, VASCULAR TONE AND THE PATIENT’S RESPONSE TO TREATMENT
HOWEVER, CVP SHOULD NOT BE INTERPRETED SOLELY BUT IN CONJUNCTION WITH OTHER SYSTEMIC MEASUREMENTS, AS ISOLATED CVP MEASUREMENTS CAN BE MISLEADING
METHODS OF CVP MONITORING
There are two methods of CVP monitoring
manometer system: enables intermittent readings and is less accurate than the transducer system
transducer system:enables continuous readings which are displayed on a monitor.
MONITORING WITH TRANSDUCERS
Transducers enable the pressure readings from invasive monitoring to be displayed on a monitor
To maintain patency of the cannula a bag of normal saline or heparinised saline should be connected to the transducer tubing and kept under continuous pressure of 300mmHg thus facilitating a continuous flush of 3mls/hr
THE CVP WAVEFORM The CVP waveform reflects changes
in right atrial pressure during the cardiac cycle
NORMAL CVP MEASUREMENTS CVP monitoring should normally show
measurements as follows:
Mid Axilla: 0 - 8 mmHg (Woodrow 2000) -
5-12 cmH2O ,-5 to 15-25cm H2O can be normal (1 mmHg = 1.36 cm H2O)
An isolated CVP reading is of limited value; a trend of readings is much more significant and should be viewed in conjuncton with other parameters e.g. BP and urine output.
Reliability of CVP
1 Bedside test Free flow from Aspiration Rapid falling water column Fluctuation with respiration No fluctuation with heart rate
2 CVP waveform CXR ไมิ�ต�ากัว�า carina ไมิ�ส�งกัว�า head of
clavicle ไมิ�ออกัไปมิากักัว�า middle 1/3 clavicle
REMOVAL OF CENTRAL LINE
THIS IS AN ASEPTIC PROCEDURE THE PATIENT SHOULD BE SUPINE WITH HEAD
TILTED DOWN ENSURE NO DRUGS ARE ATTACHED AND
RUNNING VIA THE CENTRAL LINE REMOVE DRESSING CUT THE STITCHES SLOWLY REMOVE THE CATHETER IF THERE IS RESISTENCE THEN CALL FOR
ASSISTANCE APPLY DIGITAL PRESSURE WITH GAUZE UNTIL
BLEEDING STOPS DRESS WITH GAUZE AND CLEAR DRESSING EG
TEGADERM