RN-LOGIC 3,560 Views
Joined Jan 30, '08.
Posts: 66 (35% Liked)
You should have enough time to switch your lines without worries of an air embolism. Of course, do one line at a time. Most of the time you should have blood return from your lines. The key here is that once you change your pa cath pressure tubing is to aspirate blood from the three way connection coming from the pa to prevent bubbles and make sure that the line is completely prime. The cvp you definitely have to aspirate because you are connecting it to the slic in the catheter, aspirate in the transducer. Make sure that you flush your pa cath with the three way connector turn towards the pa cath so you can flush any remaining blood in the connector. Pinching the tubing would not hurt the patient. Your patient should be flat on the bed as a preventive measure. Hope this helps.
I completely agree with you. They are trialing a new core-valve called the Evolut that has been re-sized and gives you the option to re-position the valve giving a better anchored during deployment of the valve. This decreases the chances of depressing the purkinje system. The patient's with these valves come out without pacing wires and do well.
This handy image makes me giggle.
How did it go? Wishing you the best.
My advice to you is not to focus only on one hemodynamic number. You have to look at the entire picture and then some. For example, a low H and H is not the only factor taken into account when deciding to transfuse blood. Is the balance of 02 delivery and 02 demand adequate for the patient to meet tissue oxygenation? You don't know? Take a look at your svo2. Is it low? Is your patient bleeding or simply hemodiluted. Check a lactate or anion gap just to check its adequacy by correlation. *Side note* There are other factors that can influence your oxygen delivery such as oxygenation and cardiac output. Did I say cardiac output can affect your Oxygen delivery? Well, the less stroke volume, the less oxygenated blood circulating. So, maybe in this case giving plasmanate (albumin) can increase your 02 delivery without the unnecessary risks of giving blood in this instance. In the management of hypotension for post CABG patients, increasing the patient's heart rate by use of the epicardial pacemaker is the fastest way to see results in the BLOOD PRESSURE. Remember, the pacemaker is your best friend, use it. Now, we look at the cvp/cardiac index**** you must know your patient's EF/LV FUNCTION/Tricuspid regurgation/RVH/PULM. HTN. Give fluid? maybe not. Fluid challenge sounds better----> assess for fluid responsiveness. Look at your Mean arterial pressure and afterload considering AI/MITRAL STENOSIS/LVH----> hIGH AFTERLOAD WHICH TRANSLATES INTO HIGH BLOOD PRESSURE AND INCREASE HEART WORKLOAD AND INCREASED 02 DEMAND, NOT BUENO(GOOD). I suspect that your patient was vasoconstricted due to IDK maybe hypothermia or a compensatory mechanism or etc. The have started a whiff of nipride, yikes your friend dilate just showed up you better invite fill to compensate. Bang...............
My advice for you is to simply relax, dress well, and be yourself. Be there early, 10 minutes early is considered late to my opinion. If you have any questions, post them here. However, I would not be able to answer questions that would compromise the school's interview process. Best of luck to you.
I will be class of 2017 at Our Lady of Lourdes CRNA program. I am assuming that you have already interviewed for class of 2017. Best of luck to you. Please keep me updated. I have to say that I was impressed with Our Lady of Lourdes program. Out of all my interviews, I felt right away that this program was for me. What I like about the program is that it has a smaller class (10-12 students), leading to a more personalize education. I have done my research and its reputation is excellent. The interaction with the Director and assistant re-assured me why I have made this school my number #1.
It is basic physiology not a theory.
Hey Belgian RN,
I would like to correct some of things said.
Neo gives relatively more venous vasoconstriction thus increasing preload somewhat more than levophed does. Sometimes that can convince them to add Neo instead of pusing more levophed.
I do agree that vasoconstriction increases preload. However, increasing preload by vasoconstricting its detrimental for the patient. An increase in fluid status increases your END DIASTOLIC VOLUME which increases your stroke volume.
Therefore, your preload increases. However, when you increase your levophed/neo up vasoconstrictions occur thus your afterload increases. This increased afterload increases your END SYSTOLIC VOLUME which may reflect an adequate preload but inadequate or decreased stroke volume.
Also, even though levophed has beta receptors, the alpha receptors take complete control thus the beta receptors do not play a role.
Every septic patient should be on vasopressin regardless.
I am a male RN. I highly doubt that my open chest, IABP and centrally cannulated ECMO female patient or her family have an issue with me touching such patient. I guess my definition of nursing and genders play a different role in my specialty. My advice, Focus yourself in the things that matter and stop the nonsense.
Typically a map above 60 is adequate perfusion. However, when dealing with hemodynamically compromise patients a map of 80 , just to say a number may not reflect an adequate body perfusion. A map can be affected by many variants.
The usage of a WEDGE is dependable in the patient's situation and knowledge of the provider or nurse. It should not be use for every patient.
what group are you on? I have the same article.
I start the class as well. A little bit nervous.
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