By Susan L. Woods PhD RN, Erika S. Sivarajan Froelicher MA MPH PhD RN FAAN, Sandra Adams (Underhill) Motzer PhD RN FAHA, Elizabeth J. Bridges PhD RN CCNS FCCM FAAN
Univ. of Washington, Seattle. Brandon/Hill Nursing record choice (#42). Discusses scientific cardiac nursing and present cardiac learn and know-how. This version has been completely revised and contains precis pharmacologic tables all through. concentration now incorporates a international standpoint. past version: c1995. DNLM: center Diseases--nursing.
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Extra resources for Cardiac Nursing
Artifacts: Over-damping Overshoot or ‘‘ring’’ artifact Catheter whip or ‘‘fling’’ Catheter entrapment Hybrid waveforms kink, or blood clot anywhere along the line from the catheter tip to the sensing membrane. Similarly, a loose connection or stopcock can cause inaccuracy. Transducers may be defective or poorly calibrated, which should be considered when there is difficulty maintaining transducer balance or if the data obtained appear inconsistent. The frequency response of most clinically used systems may be exceeded in the presence of marked tachycardia, preventing the collection of high-fidelity tracings.
However, note the location of the v wave on a true left atrial waveform obtained by transseptal catheterization (Figure 2-27). The true position of the v wave as seen on the left atrial waveform is during ventricular systole and the y descent correlates with the decay in left ventricular pressure. Thus, if Chapter 2—Normal Waveforms, Artifacts, and Pitfalls 31 FIGURE 2-27. This simultaneous left ventricular and FIGURE 2-25. Simultaneous left ventricular and PCWP tracings obtained during a routine cardiac catheterization protocol as a screening test for mitral stenosis.
An end-hole catheter allows the operator to determine the precise location of a pressure gradient. Unfortunately, during these efforts the tip of the catheter may become buried or ‘‘entrapped’’ within the hypertrophied myocardium and reflect intramural rather than intracavitary pressure. The resulting bizarre, spiked appearance to the left ventricular waveform may lead to a false diagnosis of a left ventricular outflow tract gradient (Figure 2-32). A hybrid tracing results when the sampled pressure represents a mixture of the waveforms from more than one cardiac chamber.