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You are here: Home / 02. Procedures / Critical Care Procedures

Critical Care Procedures

August 21, 2011 by CrashMaster

 

Arterial Lines

1 unit/cc of heparin, take air out of IV bag first.  Must have line open to air in order to zero.

risks:  thrombosis/embolism, distal ischemia, infection

the brachial artery has much higher rates of thrombosis

can use radial, ulnar, axillary, dorsalis pedis, femoral,

 

upper extremity wave form has a dichrotic cleft

SPV systolic pressure variation examines the min to max variation is one respiratory cycle.  The change down pressure is the 1st drop with inspiration.  The change u

A significant change down=inadequate preload, no change down =CHF

dominant change up=CHF or hypervolemia

 

In conclusion, there is no significant difference between heparinized and nonheparinized flush solutions for the maintenance of perioperative radial artery catheter patency. (Anesth Analg 2005;100:1117-1112)

 

and ICU a-lines (Intensive Care Medicine 1432-1238Volume 34, Number 2 / February, 2008)

 

 

MA of ultrasound showed benefit (Chest 2011;139;524-529)

 

Trick from Anaesthesia 2010

alternate to commerical aline kits

In patients on vasopressors, radial arterial lines underestimate central arterial pressure (I would posit the same phenomena in sick vasoconstricted trauma patients) (Crit Care Med 1998;26:1646)

In stable critically ill patients, non-invasive matches a-lines at arm and ankle (Crit Care Med. 2012 Apr;40(4):1207-13.)

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Intraaortic Balloon Pump

 

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Extracorporeal Support (ECMO) and Bypass

Two modes

venousarterial provides cario and pulmonary support

venous-venous provides only respiratory support

 

venous-venous is usually done with inflow to pump from IVC and blood retrun via the femoral vein

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Filed Under: 02. Procedures

Section Index

  • Arterial Lines
  • Intraaortic Balloon Pump
  • Extracorporeal Support (ECMO) and Bypass

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