1. ARTERIAL LINE AND CENTRAL LINE

2. ARTERIAL LINE:
It is a invasive arterial catheterization during – when non-invasive blood pressure monitoring becomes unreliable.
It is a cannula usually positioned in a peripheral arteries.
It allows continuous blood pressure measurement.
Arteries such as – radial artery,brachial artery,dorsalis pedis artery and femoral artery are usually used.

3. It become standard haemodynamic monitoring in situations like :
haemodynamic instability
Failure to use non-invasive techniques
therapeutic interventions in the cardi-vascular systems-under going thrombolytic therapy.
undergoing major surgery
acute hypotension or haemorrhage
obtaining blood samples for multiple blood gas analyses.
receiving vasoactive infusion,needing frequent bp monitoring

4. CONTRAINDICATIONS:
Inadequate circulation to the extremity.
Uncontrolled coagulopathy.
Extremeities with full-thickness burn or trauma
Skin infections
Raynaud’s syndrome
Buerger’s disease
A-V Fistula’s
CHOOSE APROPRIATE SITE:radial n dorsalis pedis
Brachial and axillary
Femoral

5. Check the perfusion by allen’s test
Keep all equipments ready
Set up the pressure transducing system
Positioning and preparation for cannulation
Secure the catheter and check perfusion.

7. Zero and level the transducer :Hydrostatic pressure,Atmospheric pressure,zeroing,Phlebostatic axis.
Dynamic caliberation- Accurate haemodynamic monitoring
Done by dynamic square testing:Determines the ability of the transducer to correctly reflect pressure(perform at the beginning of each shift)
Initial upstroke is produced by activation of the fast flush system
Flat line is produced for the duration of activation of flush system n reflects the high pressure present in the flush bag.(briefs for 1- 2secs)
Sharp rapid down stroke that extends beyond the baseline- reflects dynamic of the system indicates accuracy(release of fast flush device)

9. Optimally damped: one or more oscillations before return to tracing
Under damped: more than two oscillations before returning to tracing
Over damped: less than one oscillation before return to tracing
Anacrotic limb(rise) –begins at the opening of the aortic valve in early systole
Systolic peak – represents the good contractlility
Dicrotic notch-marks the closure of the aorticvalve and the beginning of diastole
Dicrotic limb : begins during late systole as the flow of blood out of the left ventricle starts to decrease
End diastole is the location at which the patient actual diastolic blood pressure is measured.

10. COMPLICATIONS:
Hematoma
Distal embolization of clot or air
Disconnection of the line
Vascular thrombosis
Infection

11. CENTRAL LINE:
Measure the pressure generated by venous blood returning –rt side of heart
Purpose for administration of vasoactive/inotrope drugs,tpn,haemodialysis
multiple lumens
Lumen connected to transducer-rigid non-compliant tubing,transducer,wide bore tube
cvc- detects the flow of blood in veins n the pressure exert by each contraction.(mech pres-kinetic)
CVC INSERTION:sub-clavian,central ,femoral
Nursing responsibilities

12. INDICATIONS:
Rapid administration of fluids amd blood products with any form of shock
Admin of vaso-active and inotropic drugs
Monitoring cvp and assessing the response to fluid or vaso-active drug therapy
Insertion of transvenous pace maker
Lack of accessible peripheral lines
Haemodynamic instability
CONTRA-INDICATIONS:
Coagulopathies or bleeding disorders
Current or recent use of fibrinolytics or anti-coagulants
Infected or burns area
Pt with high risk of pneumothorax

13. UNDERSTANDING A CVP MEASUREMENT:
Indication of rt vent filling.(RVEDP). N-0-8mmHg
Aim of fluid vol-vent pre load-sv, co
Used as a guide to determine the degree of vent loading
Consequence of overfilling wil be vent engorgement n dec.CO

14. UNDERSTANDING THE COMPONENTS OF WAVE FORMS:
A wave: atrial systole,starts just after p wave
C wave: closure of tricuspid valve,iso-volemic contraction,due to +ve pressure generatn thr will be slight bulging of valve.
X wave: represents fall of pressure in intra-atrial pressure that occures during atrial relaxation
V wave: represents passive atrial filling n follows the QRS complex.Iso-volemic relaxation.
Y descent: represents a dec in atrial pressure as the atrium empties into the ventricle due to relaxation of heart.
a- AS,c- bulge,ivc, v-rebound,ivr ,x-relaxation,y- contraction.

15. VARIATION IN WAVE FORMS:
AF:a-waves are absent
HB- a wave may be increased(cannon waves),if atrium contracts against closed tricuspid valve.
TR-c wave will be replaced by a large positive wave of regurgitation as the blood flows back into the rt atrium during ventricular contraction.-shows raised cvp
CVC ACCURANCY:depends on
patency of the line
leveling the transducer
zeroing of the transducer

16. COMPLICATIONS:
Damage to thoracic duct,nerves
Blocked cvc lumen
Air embolus
Pneumothorax
Bleeding
infection