5541 fluid challenge bag screen

LiDCO Blog

Please subscribe to stay up-to-date with the LiDCO blog

Not All Arteries Are Created Equal: Traveling Down the Arterial Tree

Posted by Jamina Cook | Oct 30, 2018 10:37:27 AM

This is a clinical education blog on why we calibrate non invasive finger cuffs to ensure the most reliable data is generated for the patient.  Listen to the audio by clicking play below...

Why calibrate non-invasive finger cuffs?

There are three different types of arteries that make up the arterial tree

  • Central arteries
    • aorta
    • pulmonary
  • Muscular arteries
    • brachial
    • radial
  • Small arteries/arterioles
    • fingers

arterial tree blog 1

https://radiologykey.com/arterial-anatomy-of-the-extremities/

 

Why calibrate non-invasive finger cuffs?

The vessel structure changes traveling down the arterial tree

  • ↑ wall thickness
  • ↑ collagen (stiffest portion of artery)
  • ↑ smooth muscle cells
  • ↓ vessel diameter
  • ↓ elastin (allows vessels to stretch during systole and shrink during diastole)


Why calibrate non-invasive finger cuffs?

There are functional changes traveling down the arterial tree

  • ↑ pressure in the L ventricle
  • Aortic valve (AV) opens→ blood is pumped into the aorta
    • systole starts
    • generates ripple force
  • Aorta fills with blood and stretches
    • makes reservoir and saves elastic energy
  • AV closes blood moves forward via elastic energy through systemic circulation
    • diastole begins
  • Pulse pressure moves through aorta as a wave
    • Shape of pulse pressure wave alters with ↑ distance from heart
  • ↑ collagen→ ↓ pressure pulsation
    • wave speed varies from 0 in arterioles to 20 in central arteries
  • ↑ smooth muscle cells →↑ hyper-responsiveness of the artery
  • ↓ diameter + ↑ vascular tone →↑ resistance to flow
  • ↑ vascular resistance with ↑ distance from the heart
  • Forearm receptors are β₂ + ∞
    • Fingers receptors are ∞
    • Finger arteries have stronger response to SNS stimuli
  • ↓ MAP & blood flow (BF) with widening pulse pressure traveling down the arterial tree
    • Reynold # for BF varies from 1 in arterioles to ~4000 in central arteries

 

Putting it All Together: Why Calibrate Non-Invasive Finger Cuffs?

Traveling Down the arterial tree

  • Arterial sizes differ
  • Arterial composition differs
  • Receptors differ
  • Response to stimuli differs
  • BP and blood flow differ

arterial tree blog 2

https://respuestas.me/q/C-mo-se-aplica-el-principio-de-bernoulli-al-sistema-cardiovascular-36064291687

“profound differences between the forearm and finger vascular beds” (Grote, 2002)

Calibration of non-invasive finger cuffs ensures the most reliable data being generated for the patient!

 

Read more evidence on the benefits of LiDCO hemodynamic monitoring

 

References:

  • Bassett, R. (2018). Finger and Thumb Anatomy. Retrieved on 8/14/2018 from uptodate.com
  • Wenger, C. et al. (1975). Thermoregulatory control of finger blood flow. 38 (6): 1078-1082. Journal of Applied Physiology
  • Olufsen (2005). Blood pressure and blood flow variation during postural change from sitting to standing: model development and validation. 99 (4): 1523-1537. J Appl Physiology.
  • Allen et al. (2002). Microvascular blood flow and skin temperature changes in the fingers following a deep inspiratory gasp. 23: 365-372. Institute of Physics and Engineering in Medicine.
  • O’Brien, C. (2002). Hypohydration effect on finger skin temperature and blood flow during cold-water finger immersion. 94: 598-603. J Appl Physiology
  • Nagasaka, T. et al. (1987). Contributions of arteriovenous anastomoses to vasoconstriction induced by local heating of the human finger. 37: 425-433. Japanese Journal of Physiology.
  • Richardson, D. et al (1988). Effects of Gravity on Regional and Capillary Blood Flows in the Human Toe. 35: 334-340. Microvascular Research
  • Wigley, F. (2018). Pathogenesis of the Raynaud Phenomenon. Retrieved on 8/14/2018 from uptodate.com
  • Ludger, G. et al. (2003). Finger plethysmography-a method for monitoring finger blood flow during sleep disordered breathing. 136: 141-152. Respiratory Physiology and Neurobiology
  • Vosse, F. et al (2011). Pulse wave propagation in the arterial tree. 43: 467-499. Ann. Rev. Fluid Mech.
  • Walloe, L. (2016) Arterio-venous anastomoses in the human skin and their role in temperature control. 3(1): 92-103. Temperature.
  • Klabunde, R. (2016) Cardiovascular Physiology Concepts. Retrieved on 8/27/2018 from https://www.cvphysiology.com/Blood%20Pressure/BP008
  • Tomlinson, L. et al. (2012). Does It Matter Where We Measure Blood Pressure? 74 (2): 241-245. British Journal of Clinical Pharmacology.
  • Tucker et al. (2017). Anatomy, Blood Vessels. Retrieved on 9/1/2018 from https://www.ncbi.nlm.nih.gov/books/NBK470401/?report=printable
  • Bortolotto, L. et al. (2006) Blood Pressure Profile Along the Arterial Tree and Genetics of Hypertension. 86 (3): 166-169. Arq Bras Cardio
  • Izzo, J. et al. (2007) Assessment of Hypertensive Target Organ Damage. Retrieved on 8/14/2018 from https://www.sciencedirect.com/topics/medicine-and-dentistry/arterial-tree
  • Grote, L. et. al (2002). Finger plethysmography-a method for monitoring finger blood flow during sleep disordered breathing. 136: 141-152. Respiratory Physiology and Neurobiology.
  • Greenwald, S. et al. (2007) Ageing of the Conduit Arteries. 211: 157-172. Journal of Pathology
  • Jani, B., et al. (2006) Ageing and Vascular Ageing. 82: 357-362. Postgrad Med J.

Topics: education, hemodynamic monitoring, minimally invasive, hemodynamics, arterial line monitoring, non invasive, operating room, arteries, arterial tree, aorta, pulmonary, muscular arteries, noninvasive hemodynamic monitoring, collagen, systole, vascular tone, arterial sizes, arterial composition, arterioles, vascular beds, MAP

Written by Jamina Cook

Jamina Cook is a Clinical Specialist for LiDCO. She has 10 years of nursing and critical care experience working in surgical, medical, and neuro ICUs. She is married with twin teenage daughters. In her spare time she enjoys being outdoors running and biking.

Recent Posts

Topics

see all

Subscribe