Advanced Hemodynamics Flashcards
What types of patients are a PA line indicated for
evaluation of cardiogenic shock
post-op cardiac patients
heart failure patients
what type of catheter is a PA line, what is most frequently used
thermodilution catheter
7.0F, 4 lumen
what is oximetric in terms of PA caths
fiberoptic strand that extends from tip
attaches to specific monitor and allows continuous monitoring of SvO2
how much air is in the PA baloon
1.5 cc of air
when is the PA balloon inflated
to facilitate insertion
to obtain PCWP
What is the termistor connector
connects to monitor for CO measurements
calculates measurements based on temperature change of room air vs. temp in pulm artery
What color is the distal port on a PA line
yellow
what is the distal port in a PA line used for and where is it located
pulmonary artery
PA pressures
obtaining blood sample (SvO2)
patency maintained by pressurized NS infusion
can you use the distal port on a PA line for medications
Never
what color is the proximal port on a PA line and what can it be used for
blue opens in rt atrium used for IV infusions CVP measurements fluid injection for CO determinants
At what length is the proximal port
30 cm
what sites can a PA line be inserted
subclavian
jugular
femoral
what is a PA line inserted through
cordis
what position must the pt be in during PA line insertion
trendelenberg
when is the balloon inflated on insertion
what will you see regarding pressure monitoring
Rt atrium ~ 30 cm mark
visualize a low threshold, bumpy waveform
what are 3 benefits of inflated baloon
prevents damage
softens tip
decreases risk of ventricular irritablity
What waveform will you see as the PA cath travels through the tricuspid valve into the rt ventricle
high threshold like mountains
can you see ventricular irritablity when the PA cath is in the rt ventricle
yes
what waveform do you see when the PA line is in the pulmonary artery
peaks with dichrotic notch (art line)
What does a CVP tell you about CO
What is the normal range
preload
2-6 mmHg
which side of the heart does the CVP tell you about
Right
What is normal pressure in the RV and when is it seen
20-30/0-6
only seen during insertion
What is the normal pressure for PAS
20-30 mmHg
what does PAS stand for
systolic pulmonary artery
what does PAS tell us regarding CO?
What side of the heart
Afterload
Rt side
What is PAD
Diastolic pulmonary artery
What is the normal range for PAD
what does it tell us about CO
what side of the heart does the PAD represent
8-15 mmHg
preload
left
What is PCWP
pulmonary capillary wedge pressure
what is the normal range for PCWP
what does it tell us about CO
what side of the heart does it represent
8-12 mmHg
Preload
Left
What do CO and CI indirectly tell us regarding CO
contractility
What is the normal range of CI
2.5-4 L/min/m^2
what is the normal range for CO
4-8 L/min
What is SVR
what is the normal range
What does it tell us about CO
what side of the heart
systemic vascular resistance
800-1400 dynes/sec/cm5
afterload
left
what is normal SvO2
what does it tell us
60-80%
oxygen supply and demand
What are some common complications of PA line insertion
pneuomothorax
tamponade
arrythmias
what position must patients be in for accurate measurements with PA lines
supine with HOB raised
what does the pulmonary artery pressure tell us
pressure of blood flow going to the lungs
When would you see increased PVR
increased in pulmoanry vasoconstriction such as COPD, pulm HTN, ARDs, PE
What does PCWP tell us
more accurate indciator of LV preload
What can be used as PCWP
PAD
but difference should be 1-4 mmHG greater in PAD
what does CI take into account compared to CO
body surface area
what does thermodilution calucate
how fast it takes for cooler blood to reach distal sensor in PA
if contractility is decreased takes longer to get to sensor
what does the CO curve look like for high CO
quick peak and quick return to baseline
small area under curve
boluses move base thermistor quickly
what does the CO curve look like for low CO
lower peak over longer period
big area under curve
boluses mixes with blood and takes longer to move past thermistory
what is spontaneous wedging?
what are signs and symptoms that it has occured
PAC wedges into smaller artery branch and occludes blood
will see spontaneous appearance of PCWP tracing
prolonged wedge time
requires prompt intervention
what will you observe if the pulmonary artery becomes ruptured or perforated
acute hemodynamic instability
decrease in SaO2
bloody ETT secretions
who are most at risk for PA rupture or perforation
those with riable PA i.e. longstanding pulmonary HTN
how can you minimize the risk of PA rupture or perforation
avoid wedging
correct placement
avoid overinflation
close observation during wedging and cessation of balloon inflation
What are 6 causes of a dampened waveform
air in monitoring system –> flush
blood in tubing –> flush
clot in system –> aspirate DO NOT FLUSH, MRP
kinked catheter, wedged, wrong pos –> have pt cough, flush, check xray
loose conections –> tighten
what can cause PCWP to be unobtainable
ruptured balloon ->notify MRP
incorrect cc of air in baloon -> deflate and re-inflate
malposition–> MRP
What can cause spontaneous change in waveform from PA to PCWP (auto-wedge)
catheter wedged –> DB &C, change pt position
notify MRP for reposition
ensure baloon not inflated
RV waveform
cath slipped back into RV -> MRP
when baloon inflated wedge pressure drifts up/down on monitor
balloon overinflated ->when waveform changes form PA to wedge stop inflating
catheter not in far enough -> MRP
transducer incorrectly connected or not open to pt –> check and correct
false low PA pressure values
tip of cath against wall –> flush or reposition
transducer higher than phlebostatic axis –> reposition
disconnected/loose tubing –> troubleshoot
false high PA pressure values
transducer lower than phlebostatic axis
clotted catheter - aspirate clot
catheter kinked under dressing
What value tell you rt sided preload?
left?
CVP/RA
PCWP, PAD
What value tell you afterload for the rt side?
left
PVR
SVR
What are treatments for high preload
diuretics/nitro
what are treatments for low preload
fluids
what are treatemnts for high afterload
vasodilators, nitric oxide, nipride, milrinone, dobutamine
what are treatments are for low afterload
domapine, levophed, epi, phenyl
what meds are given for high contractility
beta blocker
calcium channel blocker
what meds are given for low contractility
dopamine, epi, dobutamine, milrinone
what will RA be like in hypovolemic, cardiogenic and septic shock
hypovolemic: low
cardiogenic: high
septic: low
what will PCWP be in hypovolemic, cardiogenic and septic shock
hypovolemic: low
cardiogenic: high
septic: low
what will CO be in hypovolemic, cardiogenic and septic shock
hypovolemic: low
cardio: low
septic: low
what will CI be in hypovolemic, cardiogenic and septic shock
hypovolemic: low
cardio: low
septic: low
what will SVR be in hypovolemic, cardiogenic and septic shock
hypovolemic: high
cardiogenic: high
septic: low
