PA Pressure w/ Swan-Ganz Flashcards
Label the following picture.
1) Big white connector = Thermistor connection
2) Orange wire = paceport connector
3) Yellow wire only = Tip of swan-ganz
4) Yellow wire with white connector = PA port
5) Blue wire = Proximal port
6) Red wire = Injection port for balloon
How long is a a normal Swan Ganz catheter?
110 cm
What can the paceport be used for (2)?
- Pacing the right ventricle
- As a venous infusion port
A. What often occurs as a result of the catheter residing in both the atrium and ventricle?
B. If this issue does not resolve on its own, what can you do to fix it?
A. Ectopy
B. Give boluses of Lidocaine or start an infusion (to reduce the excitability)
A. How many lumens does a typical Swan-Ganz cather have?
B. Name each of them.
A. 4 lumens
B. Thermistor, balloon, infusion, and distal lumens
What curve do you get from the thermistor?
Thermodilution curve
What pressure does the distal lumen give you?
PA/PCWP (pulmonary artery/pulmonary capillary wedge pressure)
What does the proximal lumen give you?
RAP (right atrial pressure)
What is the maximum volume you can inject into the bung stop (retard)?
1.5 cc
How many centimeters from the PA distal end is the thermistor opening?
3 cm
How many centimeters from the PA distal end is the RV port opening?
19 cm
How many centimeters from the PA distal end is the proximal injectate port opening?
30 cm
What main manufacturer makes the paceport catheter with the right ventricular port which allows for passage of a ventricular pacing wire?
Chandler (the Chandler Ventricular Pacing Probe)
A. What is the external diameter of the Swan-Ganz catheter?
B. What is the minimum introducer size?
A. 7.5 French
B. 8.0 French (want this to be 0.5-1.0 French sizes larger than the catheter)
Where do you place the introducer, and in what position should the patient be in when placing it?
Into the RIJV (like CVL) with patient in Trendelenburg
What is passed over the guidewire (consists of two components)?
A percutaneous introducer consisting of a vessel dilator and sheath
What does VIP stand for (part of the Swan-Ganz)?
Venous infusion port
What change do you see in the waveform as you pass the catheter from the RA to the RV?
Sharp increase in “systolic” pressure
As the catheter tip enters the pulmonary artery, a ____ may occur in the systolic wave, and the diastolic pressure will ____ in magnitude and will be ____-sloping.
dicrotic notch
increase
down-sloping
With further advancement of the cather, the balloon will occlude blood flow and the tip will record the _____ pressure, which is characterized by what?
Will record the pulmonary artery occlusion pressure, characterized by disappearance of the “systolic” pressure wave and reappearance of venous a, c, and v waves
When the ballon is inflated to occlude the pulmonary artery, the distal port of the catheter measures ___ which ordinarily reflects ___ pressure?
the venous backpressure downstream from the balloon
left atrial pressure
Right ventriclular pressure shows a ___ systolic pressure than seen in the right atrium, although the end-diastolic pressure are ___ in these two chambers.
higher
equal
Right ventricular systolic pressure = ?
RVSP = PASP (pulmonary artery systolic pressure)
The pulmonary artery occlusion pressure (PAOP) = WEDGE pressure, which is also equal to what other two pressures?
LAP and LVEDP
RAP equals what?
RVEDP
RVEDP < ?
PADP
PADP is approximately equal to what two pressures?
LAP and LVEDP
Pulmonary artery wedge pressure measurement creates a ____ of blood connecting the catheter tip to a junction point where flow resumes in the pulmonary veins near the left atrium.
static column of blood
In order to provide an accurate measure of pumonary venous or left atrial pressure, the tip of the PA catheter must be wedged in which lung zone? Why?
Lung Zone 3
Because alveolar pressure must be the lowest pressure in the zone in order for the wedge pressure to reflect intravascular pressure instead of alveolar pressure.
Zone 1: P(A) > P(a) > P(V)
Zone 2: P(a) > P(A) > P(V)
*Zone 3: P(a) > P(V) > P(A)*
Pulmonary artery wedge pressure a-c and v waves occur ____ in the cardiac cycle than their counterparts on the right side of the heart seen in a CVP trace.
Later
The LAP and CVP waveforms have nearly identical morphologies, but the CVP a wave slightly ____ the LAP a wave (temporal relationship between the two waveforms).
precedes
True/False
Pulmonary artery wedge pressure (PAWP) is a damped, delayed reflection of left atrial pressure (LAP).
True
What causes the artifactual pressure peaks and troughs in the pulmonary artery pressure waveform?
Catheter tip motion
A. What is overwedging of the pulmonary artery catheter?
B. What does overwedging of the pulmonary artery catheter cause?
C. Solution?
A. When the catheter tip impinges against the vessel wall, or balloon herniation over the catheter tip
B. Artifactual waveforms (saw-toothed waveform)
C. Immediately deflate the balloon and withdraw the catheter 1-2 cm. Slowly reinflate the balloon until waveform returns to normal
Above what PA pressure should you cancel the case until the patient’s pulmonary hypertension is under control?
Above PA pressures of 60 (under 40 is normal systolic PAP)
You should minimize the number of PCWP measurements in which patient populations (3)?
- Elderly
- Anticoagulated
- Pulmonary HTN
If PA diastolic pressure is < ___ mm Hg, use PA diastolic pressure rather than PCWP as an index of left ventricular filling pressure.
18 mm Hg
Upon transition from the PA to the pulmonary capillary wedge pressure trace, what should you do?
Immediately stop inflation!
Distances from RIJV insertion site to
a) right atrium?
b) right ventricle?
c) pulmonary artery?
d) pulmonary artery wedge?
RIJV is
a) 20 cm from RA
b) 30-35 cm from RV
c) 40-45 cm from PA
d) 50 cm from PAW
*if asked for one number instead of range, choose the bolded, underlined value
Advantages of percutaneous cannulation of the central internal jugular vein?
- Rapidly accessible
- Does not interfere w/ CPR
- Provides a straight route to the heart
- Less restrictive to patient movement
Disadvantages of percutaneous cannulation of the central internal jugular vein?
- Air embolism, carotid artery puncture, &/or tracheal injury may occur
- Pneumothorax (more common in the left than the right internal jugular vein)
- Thoracic duct injury (left internal jugular vein only)
Equation for Systemic Vascular Resistance
SVR = (MAP - RAP) / CO
Equation for Pulmonary Vascular Resistance
PVR = (PAP - PCWP) / CO
To convert HRU (Wood units, or hybrid resistance units) to ARU (absolute resistance units), multiply by ___?
HRU –> ARU, multiply by 79.9
What is normal range for PA end-diastolic pressure?
4-12 mm Hg
What is normal range for pulmonary artery wedge mean pressure?
4-12 mm Hg
What is normal range for LA mean pressure?
2-12 mm Hg
What is normal range for LV end-diastolic pressure?
5-12 mm Hg
True/False
PA end-diastolic pressure is a good indicator of pulmonary artery wedge pressure–if no change in PAEDP, then there is no need to check PA wedge pressure.
True
A. Normal range for CO (L/min)?
B. Normal range for SV (mL)?
A. CO = 4.0-6.5 L/min (or 5.0)
B. SV = 60-90 mL (or 75)
What risk factors are associated with pulmonary artery perforation (6)?
- Advanced age
- Hypothermia
- Pulmonary HTN
- Female gender
- Radiation therapy to the area (e.g. for breast cancer)
- Deviations from standard insertion techniques
Mechanisms of pulmonary artery perforation (3)?
- Tip perforation of the vasculature
- Eccentric balloon configuration propelling the balloon through the vessel wall
- Balloon inflation disrupting the pulmonary artery (mean intraballoon pressure = 250 mm Hg)
Go to answer
BOO!!!!!!
