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Certified Registered Nurse Anesthetist (CRNA) /

arterial waveform cascade



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Jun 14, 2007 05:57 PM

arterial waveform cascade


In clinicals today, a CRNA asked me about the significance of an arterial cascade pattern. I had never heard of this and I'm having trouble finding information on it. He was describing it as an up and down variation in the height of the arterial waveform. Does anyone know anything about this? Any info is appreciated. Thanks!

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6 Comments
No. 1
from Focker
Old Jun 14, 2007, 06:16 PM

Default Re: arterial waveform cascade
pulsus paradoxus? Never heard of it referred to as the arterial cascade pattern though.
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No. 2
from skipaway
Old Jun 14, 2007, 06:32 PM

Default Re: arterial waveform cascade
You can evaluate hydration status by observing the arterial waveform and the SpO2 waveform. With an obvious up and down pattern, noting the downward pattern occurs during diastole, you can make the assumption the patient is dry. It has been years since I learned about this and I'll have to go try to find out the exact causes, but I still look for these cascades when I'm with a patient. Maybe this will help guide your search.
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No. 3
from cardiacRN2006
Old Jun 14, 2007, 06:50 PM
Updated Jun 14, 2007 at 11:15 PM by cardiacRN2006

Default Re: arterial waveform cascade
...,,
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No. 4
from dfk
Old Jun 14, 2007, 07:38 PM

Default Re: arterial waveform cascade
i also learned, thanks to anesthesia school, that the amplitude of the ECG can tell you something about fluid status. as for the arterial cascade, i have used the ECG cascade to get/keep baseline rhythm at start of case, but perhaps the arterial cascade is similar and allows the ability to detect fluid status intra-op?
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No. 5
from ralatek
Old Jun 15, 2007, 01:01 PM

Default Re: arterial waveform cascade
The way it was explained to me was that during PPV, intrathoracic pressure increases and venous return to the R heart decreases thereby decreasing LV preload and hence, decreasing arterial blood pressure. During periods of hypovolemia this up and down tracing of the a-line waveform becomes more apparent and can be used as a rough estimate of volume status. I've tried to reference this explanation in a textbook with no luck. Any other opinions??
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No. 6
from Nitecap
Old Jun 21, 2007, 01:41 PM

Default Re: arterial waveform cascade
A-line wave form analysis

Upstroke - contractility
Down stroke - SVR, Volume status
Level of dicrotic notch - Volume status, SVR, norm should be in upper 1/3 of downstroke
Area under curve - Stroke volume
Respiratory variability - volume status.
Square wave tests - assess to see if under or over dampened
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