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Arterial Blood Pressure MonitoringCourse DescriptionCredit Hours: 2 Authors: Christina DeBernardo, MSN, RN, CNL The purpose of this course is reinforcing arterial blood gas interpretation skills. Accreditation Information: KLA Education Services LLC is accredited by the State of California Board of Registered Nursing, Provider # CEP16145. Course Certification: Once you have completed this course, click on the “Print Certificate” option below to save or print your CE course certification. If you are not yet registered in a course plan with IvyLeagueNurse, please complete the registration and payment process so that you are able to log into your account and fully obtain your course certificate. Our affordable and unlimited one-year CEU plan starts at just $19.99. Print Certificate Print Course Course ObjectivesUpon completion of this course, the course participant will be able to:
Course ContentIntroductionWhat is Arterial BP monitoring and how is it done?
EquipmentDisposable pressure tubing with dead end caps Transducer System SetupDead end caps on the stopcocks Preparing the Monitor & Tubing SystemImproper systems can cause erroneous measurements of hemodynamic indices which can potentially invalidate a patient’s entire hemodynamic profile. The most frequent complication of invasive BP monitoring is equipment misuse and misinterpretation To ensure accuracy:
Priming the Pressure Tubing
When to Zero the TransducerWhen do leveling and zeroing of the transducer need to be done? Whenever the reference point on the patient changes the air-fluid interface changes. Zeroing the Transducer Reference Point1. Place HOB from zero to 45 degrees 2. Position the patient and the transducer at the same level 3. Make sure the transducer is located at the phlebostatic axis
Zeroing the Transducer
By opening the stopcock to air, the monitoring system uses atmospheric pressure as a reference for zero. Pressing the zero button negates the effects of atmospheric pressure so that the pressure values reflect only those of the patient.
Once Transduced...
Dynamic Response/Square Wave TestObserving the waveform and performing a square wave test determines whether the system is damped Should be performed:
How to Perform a Square Wave Test
Note that the patient’s waveform has all components; anacrotic limb, dicrotic limb, dicrotic notch (Figure 3). If this is observed, no adjustment in the monitoring system is required. The system is optimally damped (Figure 4). Square Wave Tests that Require AdjustmentsNormal Square Wave Test Overdamped System Underdamped System Images credit: Wiegand, D.L. (2011) Overdamped System
Trouble Shooting an Overdamped System
Underdamped System
Trouble Shooting an Underdamped System
Maintaining an A-line
Blood Draw with Vacutainer
Removal of Non-sutured Arterial Catheter
Documentation
Precautions/Key Points
ReferencesImperial-Perez, F. and McRae, M. (2002). Arterial pressure monitoring. Critical Care Nurse, 22(2), 70-72. Lippincott Williams & Wilkins (2011). Lippincott’s Nursing Procedure and Skills. Arterial pressure monitoring. Retrieved June 30, 2011 from, http://procedures.lww.com/lnp/view.do?searchQuery=Arterial%20pressure%20monitoring&pId=912702 Lippincott Williams & Wilkins (2011). Lippincott’s Nursing Procedure and Skills. Transducer system setup. Retrieved June 30, 2011 from, http://procedures.lww.com/lnp/view.do?searchQuery=Transducer%20system%20setup&pId=164403 McGhee, B.H. & Bridges, E.J. (2002). Monitoring arterial blood pressure: What you may not know. Critical Care Nurse, 22(1), 60-79. Rauen, C.A., Makic,m.B., & Bridges, E. (2009). Evidence-based practice habits: Transforming research into bedside practice. Critical Care Nurse 29(2), 46-59. Wiegand, D.L. (2011). Arterial catheter insertion (assist), care, and removal. AACN Procedure Manual for Critical Care (pp534-547). St. Louis, MO: Elsevier. Course DescriptionCourse ObjectivesCourse Content
Course ExamBefore you receive your certificate, you must complete the exam and achieve a score of % or higher. (You have unlimted attempts). This exam is required by your state licensure. ExamExamWe are required to delay the exam hours. Check back soon! ExamWe are required to delay the exam until you have had time to view the course material. Please view the course first! No Licenses on FilePlease add a license to your account before you continue. Thank you! What is the nurse's responsibility for an arterial line?Along with understanding waveforms on the monitor, the nurse is responsible for zeroing (calibrating) the arterial line. Zeroing the system tells the transducer to “ignore” the pressure from the atmosphere. First, ensure the transducer pressure tubing and flush solution are assembled correctly and free of air bubbles.
How do you monitor intraInvasive (intra-arterial) blood pressure (IBP) monitoring is a commonly used technique in the Intensive Care Unit (ICU) and is also often used in the operating theatre. The technique involves the insertion of a catheter into a suitable artery and then displaying the measured pressure wave on a monitor.
What routine assessment would you do on a patient with an arterial line?Monitor Arterial Site
Arterial line sites/dressing should be kept as visible as possible. Check the site q1h and prn to assess for bleeding. Use minimal dressing material. Assess distal extremity for evidence of compromised color, circulation or motion q1h.
What is arterial pressure monitoring used for?Arterial pressure monitoring is a form of invasive blood pressure monitoring and is done through the cannulation of a peripheral artery. This form of monitoring is commonly utilized in the management of critically ill and perioperative patients.
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