Good Morning All! today we are going to learn about devices needed to measure blood pressures more quickly and more accurately than the standard Bp cuff. Blood Pressure is made up of the upper number (systole) where the heart is actively contracting and the bottom number (diastole) where the heart is at rest. These devices are used when a patient needs to be watched very closely. Don’t worry, this is not nearly as ‘bloody’ as the lecture on ORIF.
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The Placement and Use of Invasive IV Catheters.
Intravenous Catheters (IVC) are basically a tube that is placed within a vein or artery for the administration of medications or measuring of labs or collection of samples. They are widely utilized across the spectrum of health care delivery. Everyone has seen them in use; they are ubiquitous in healthcare and IV lines are always used in film to dramatize just how ‘ill’ the patient is.
Intravenous access is not limited to the standard IV. There are specialized devices for an array of procedures and medical needs. This paper will focus on the care and use of the Swan-Ganz Catheter (Pulmonary Artery Catheter, PAC)1 and variations for assessing pulmonary artery pressures and mixed venous oxygen saturation (SvO2), hemodynamic instability (ineffective tissue perfusion, decreased CO, and Fluid volume excess or deficit), and a direct measure of cardiac output and for Pacing when needed. Placement of the Swan-Ganz PAC can be seen here, and here (from the manufacturer). Arterial IV lines will also be covered later.
This is an excellent video:
The PAC can have several different hub options on the proximal end with complimentary ports and and always a balloon distal end. The purpose of the PAC is to measure pressures inside the right side of the heart and to insert temporary pace maker leads in case of arrhythmias if needed. The right side has deoxygenated blood returning from the body through the heart to the lungs. The Arterial Line that measures the oxygenated blood flow from the heart to the left side of the heart to the body will be discussed later. Internal measurement combined with other test and laboratory results can reveal the health and functionality of the heart and if there is progress in the given path of treatment.
As the above video shows, the PAC is placed through the skin and into the either the right internal or external Jugular Vein where measurement of pressures can begin. The Pressures measured are the same two measurements of blood pressure: Systole (the pumping portion of the cardiac cycle), Diastole (the resting portion of the cardiac cycle). Then the catheter tip is ‘floated’ into the Right Atrium (2-6mm Hg), then through the Tricuspid Valve, into the Right Ventricle (15-25/0-8 mm Hg), and then through the Pulmonic Valve into the Pulmonary Artery (15-25/8-15 mm Hg) that carries deoxiganated blood to the lungs. The Nurse will note that there cannot be a diastolic measurement until after the catheter passes a valve. There will be a trace diastolic pressure in the right ventricle, however the probe will have to pass the pulmonic valve and move into the pulmonary artery where a noticeable diastolic pressure will occur. This is where the Pulmonary Artery Systolic and Diastolic Pressures can be recorded.
Measuring pressures of the left side of the heart is far easier. The simplest way is to use a blood pressure cuff. However, an Arterial Line can be placed when indicated; this occurs normally in the of the Radial or Ulnar Artery of the forearm just proximal of the wrist The Arterial Line is used to asses Hemodynamic instability, continuous blood pressure monitoring (thereby assess the efficacy of vasoactive medications), and to allow for frequent, quick, and painless blood gas draws.
An Arterial Line is placed using a sterile field, then, secured, covered with a bio-eclusive film, and then is attached to a transducer system. The zeroing stopcock must be level with the patient’s phlebostatic axis located at the anterior-posterior mid-point of the chest wall. Zeroing the transducer system prevents hydrostatic pressure error on this liquid closed system. Failure to zero will cause large errors. The system monitors blood pressure very accurately when it may change rapidly either from medicines or physiological changes in the patient.
ugghhhh….not more medical stuff
ps
saw the pics of the twins
they are so cute!!
momcat wrote:
hey you!
glad to hear that you are home!
i’m going to bet that momcat ha an arterial line placed while she was in icu…
@ coldwarrior:
i had a pic line
at one point in icu I had 6 lines running into me
momcat wrote:
6?
that is a lot of hardware.
how is your strength? getting better?
getting there
arms are stronger than my legs
and the bruises on my arms are fading
at one point my left arm was black from my wrist to my elbow
@ momcat:
did they have you on a a ventilator?
@ coldwarrior:
for the first 2 days
I definitely did not like the one time I had to wear a catheter. Let’s just say driving was not fun and leave it at that!8)
@ Macker:
The removal of the male urinary catheter is one of the most painful memories that I have.
Thank you SO MUCH for reminding me!! LOL!
@ Bumr50:
OWIE!
@ momcat:
momcat, so glad to hear that you are home and on the road to recovery, albeit probably not fast enough in your mind.
@ coldwarrior:
Nothing more satisfying than to see a screen with good waveforms with an aline and pa cath — nothing more fun than manipulating the numbers via drips for optimal CO/CI.
@ Bumr50:
Going in is usually worse, getting it out is relief, just sayin’.
@ Calo:
Out was MUCH worse for me.
Herman Cain sings ‘God Bless America’ in 9/11 tribute.
i see that geller and bob spencer are still beating on the ‘perry is a jihadist’ drum
i guess they havent milked enough money out of that non-story yet.
@ Calo:
titration is your friend!
coldwarrior wrote:
Please spare us the details…
coldwarrior wrote:
Or just possibly they really honestly dont trust Rick Perry. I mean after all, Rick Perry is rather uncomfortably closely connected to a very prominent Hamas financier. And for god’s sake please dont tell me you dont know that.
coldwarrior wrote:
A little more accurate…
coldwarrior wrote:
Deleted by “viewers like you”!!
//
It must be difficult to be a jihadist and a Christian Dominionist at the same time… Perry obviously has great talent since he apparently can do that.
@ Bumr50:
Thanks for posting that. Gave me chills. Third time this morning I have been in tears. Going to be a rough weekend for me.
@ Dolphin:
He has a great voice.
The article where I found that said that he did it one take.
I’d throw up the vid, but afraid to drag the thread this early.
Dolphin wrote:
As your friendly neighborhood retired nearly practically almost famous Rock Star, I prescribe 2 bottles of Samuel Adams Oktoberfest per hour and plenty of BBQ Pork Ribs until your condition improves.
@ doriangrey:
i’ll refer to his actual record and statements on israel then i will worry about his ‘friends’. see the problem with the word ‘friend’ is we dont really have any context. does he hang out with this guy all the time? or has he met him once or twice? these are things i need to now about this (and i would say this regardless of the candidate).
i did a quick search on he topic and 1st up was debbie schlussel’s page, so that makes me pretty skeptical and puts me in the need for some serious fact checking because i will not take anything she says without finding out where she is half truthing it and where she is outright lying.
lots of time to go yet, lots of things to read on him before i cast my vote.
doriangrey wrote:
oh, the media would have been apoplectic is she said that!
This might be one Saturday morning lecture I skip. There is a reason I went into electrical engineering in college rather than bio-engineering. I can’t watch these things. It’s really quite strange…I can lok inside my own cuts and wounds but not someone elses.
Momcat – glad your home and getting well!!!
Bumr50 wrote:
As a former professional recording artist let me say, that is very impressive. Vocals traditionally are one of the hardest parts of any recording to get perfect, let alone acceptable. 10 or 20 takes are not unusual at all.
In fact most professional vocalists record their vocal tracks one line at a time, doing that line four or five times to get exactly what they want. Doing the vocals is usual a very long and drawn out process.
@ doriangrey:
He’s a Baptist preacher, and therefore probably gets a lot of practice.
Here he is on Stossel’s show singing a few bars unaccompanied.
coldwarrior wrote:
The guy in question is Farouk Shami, and no I don’t think their is any serious long term close friendship between them, nor do I think the fact that Shami donated heavily to Perry’s 2010 campaign and was rewarded with a significant role in Perry’s 2011 Inaugural Committee is of any profound significance. Shami, besides being a Palestinian supporter and Hamas financier is also a well know uber Texan.
Much ado about nothing if you ask me, but there is no doubt that their are people who would consider this extremely problematic.
Bumr50 wrote:
That’s so much harder than most people realize.
Ah screw it…
CW can yell at me!
It’s good enuff to post IMHO, and I’m getting irritated at the Left’s response to it.
Alrighty, then. I’ve got all my catheters hosed off, greezed up, coiled up and put back in the garage with the jumper cables, etc… When’s that football thread going up?
@ doriangrey:
the problem with all of this shrieking harpieism is that when something actually comes up and is very bad, no one will pay attention…the old tale about the boy who cried wolf applies here
huckfunn wrote:
‘leven thirty
@ coldwarrior:
Yay; we’e almost there.
@ coldwarrior:
It’s spurred on by Geller & Co. further by their doubling down every time someone tries to explain the situation and provide some perspective.
That’s the problem with single-issue attack dogs.
@ doriangrey:
I LOVE Sam Adams!
@ Macker:
Winter Lager and Scotch Ale are really the only two Sam varieties that I purchase.
Macker wrote:
He was a great patriot and I’m thankful that he invented pretzels.
@ huckfunn:
But did he found the Republican party?
//
Does anybody know if the Flight 93 memorial ceremony is being televised anywhere?
I know it starts at 12:40 ET.
Bumr50 wrote:
Yep; right after he invented the Intercontinental Ballistic Railroad.
coldwarrior wrote:
True, some of us do our homework, sadly most do not. This is how I know about Shami, I did my homework about Perry and his Islamic connections. It’s why I dont think it is a big deal.
Just like his immigration stance, his policy is not one entirely to my liking but it isn’t bad enough to seriously offend me either.
I don’t consider Rick Perry to be a strong conservative, but I haven’t seen anything to suggest he is a liberal either. I see him as either a conservative leaning Moderate or perhaps a moderate leaning Conservative.
I think Sarah Palin is a much better candidate, but Rick is certainly an acceptable candidate from what I know of him at this point. It would take something very bad popping up at this point for my opinion of Rick Perry to change from positive to negative.
Bumr50 wrote:
Oh, you have to try the Oktoberfest, it’s really good.
@ Bumr50:
CSP1
is cw here?
I have a med question
need some advice on a fingertip oxymeter
@ Dolphin:
Thanks!
momcat wrote:
yes…
@ Bumr50:
Probably on line also @ cspan. I have the link on the laptop if you need it.
@ Dolphin:
Ya I got it, thanks!
@ coldwarrior:
is this a good one
http://www.amazon.com/Nonin-Digital-Oximeter-Concords-Super-Safe/product-reviews/B0047DYM28/ref=cm_cr_dp_all_helpful?ie=UTF8&showViewpoints=1&sortBy=bySubmissionDateDescending
@ momcat:
yep. and its made here, so…bonus!
and it is military airworthy certified so you shouldnt have any problems with durability and operational parameters
@ doriangrey:
Two things that are in painfully shot supply around here, unfortunately.
I tried the beef ribs from one of the local places the other night.
Just not the same…
In other news, I haz new satellite box!
This one has SkyNews, so that’s a plus.
And several cricket channels…
lobo91 wrote:
i would be all over that.
@ coldwarrior:
cool!
thanks
@ lobo91:
Know it or not, you’re up to your butt there in Pakistanis, Sri Lankans, Indians and Bangladeshis, so the cricket is a must-have. As bad as it is, it beats watching Arabic “football.” Which looks a lot like volleyball to the inexperienced eye.
coldwarrior wrote:
I’ll trade them for some ribs…
@ Mike C.:
We have tons of them working at Arifjan.
@ lobo91:
I’ll bet you do…
Military police are investigating the disappearance of nearly 14,000 rounds of ammunition from Fort Bragg, according to a spokesman for the 82nd Airborne Division.
Not a whole lot of 5.56 if you ask me, however if those 14 boxes accidentally fell off a truck where I might find them, it would cut down my current ammo bill quit a bit.
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