Q: Air bubbles in the arterial line tubing will cause? (select one)
A) Under damping of waveforms
B) Over damping of waveforms
Answer; B
By standard the "fast flush" test should be performed after inserting an arterial line, to test the dynamic response of the monitoring system to pressure. This is performed by quickly opening and closing the valve in the continuous flush device. Normal waveform during 'flushing' is a square wave displacement on the monitor, followed by wiggling and a return to baseline.
Air bubbles in the tubing are common and cause over-damping of response. Other causes of overdamped arterial line waveform are overly compliant tubing, kinked catheters, blood clot within the tubing, no fluid, or low flush bag pressure.
On the other hand, an underdamped waveform is due to excessive tubing lengths, tachycardia, or high output states.
(see reference # 2 for video)
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References:
Kleinman B, Powell S, Kumar P, Gardner RM. The fast flush test measures the dynamic response of the entire blood pressure monitoring system. Anesthesiology 1992; 77:1215.
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