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ARTERIAL LINE AND CENTRAL LINE

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Presentation on theme: "ARTERIAL LINE AND CENTRAL LINE"— Presentation transcript:

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.

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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)

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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


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