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ARTERIAL LINE
What is an arterial line? An arterial line is a cannula usually positioned
generated in the arteries following ventricular contraction and can be described as having: Dicrotic notch Peak systolic pressure Diastolic pressure
Resonant: spiked
Due to
tracing
Long, stiff ,non-complaint tubing Increase vascular resistance Non fully opened stopcock valve OVERESTIMATE blood pressure If doubt: NIBP
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
(basilic vein is the best) in the arm and is advanced into the central veins
CENTRAL LINES
Indications for CVP lines are: fluid resuscitation Parenteral feeding measurement of central venous pressure poor venous access
Cardiac arrhythmias
air emboli
VOLUME
TO ASSIST IN MONITORING CIRCULATORY
FAILURE
CARDIAC FUNCTION, CIRCULATING BLOOD VOLUME, VASCULAR TONE AND THE PATIENTS RESPONSE TO TREATMENT
HOWEVER, CVP SHOULD NOT BE INTERPRETED
SOLELY BUT IN CONJUNCTION WITH OTHER SYSTEMIC MEASUREMENTS, AS ISOLATED CVP MEASUREMENTS CAN BE MISLEADING
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
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)
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 carina head of clavicle middle 1/3 clavicle
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