Critical Care Procedures

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

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.)

Intraaortic Balloon Pump

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