APA wk4 CVP and swan ganz presentation

Question 1

Placement of central venous catheter in right atrium can cause

Answer 1

dysrhythmias, thrombus formation, and cardiac perforation

Question 2

Distance of central venous by insertion site: subclavian, right IJ, Left IJ

Answer 2

10cm, 15cm, 20cm

Question 3

where does tip of central venous catheter sit?

Answer 3

Vena Cava just above the junction with the right atrium

Question 4

Balloon of PAC should not be inflated more than how long and no more than how many cc of air?

Answer 4

Do not inflate greater than 15 sec or with more than 1.5ml of air.

Question 5

Distances associated with PAC from vena cava to right atrium, right ventricle, pulmonary artery, and PAOPposition?

Answer 5

0-10cm,
10-15cm,
15-30cm,
25-35cm

Question 6

Potential complications of obtaining venous access with central lines?

Answer 6

Arterial puncture,
pneumothorax,
air emoblism,
neuropathy,
catheter knot

Question 7

Potential complications of central catheter residence?

Answer 7

Bacterial colonization of catheter,
Bacterial colonization of heart or pulmonary artery,
myocardial or valvular injury,
sepsis,
thrombus formation,
thrombopretation,
misinterpretation of data

Question 8

Complications of floating PA catheter?

Answer 8

pulmonary artery rupture,
right bundle branch block,
complete heart block( if pre-exisiting LBBB),
dysrhythmias

Question 9

What is the most common complication while obtaining central access?

Answer 9

Dysrhythmias

Question 10

What type of patient do you not float the PAC in?

Answer 10

Left bundle brach block

Question 11

What can advancing the catheter into the RV cause?

Answer 11

a Right bundle brach block and put pt in a complete heart block

Question 12

How many days does the incidence of catheter related infection increase?

Answer 12

3 days

Question 13

What are some things to consider before use of PAC or central line?

Answer 13

LBBB,
tricuspid or pulmonic valve replacements,
presence of endocardial pacing leads,
anticoagulation,
Inadequate clinical support,
There are no absolute contraindications to PACs(risk-benefit be assessed)

Question 14

CVP waveforms

Answer 14

A wave- right atrial contraction
C wave- right ventricular contraction,
x descent - RA relaxation
V wave-Passive filling of RA
y descent- RA empties through open tricuspid valve

Question 15

when should you measure a CVP?

Answer 15

at END-EXPIRATION because extravascular pressure equals atmospheric pressure, allowing us to measure CVP relative to atmosphere pressure. (it is not affected by intrathoracic pressure at end-expriation)

Question 16

What is CVP a function of?

Answer 16

1. Intravascular volume
2. Venous tone
3. Right Ventricular compliance

Question 17

Normal CVP reading?

Answer 17

1-10mmHg

Question 18

What patient will a CVP not be accurate?

Answer 18

RV failure

Question 19

Causes of high CVP?

Answer 19

transducer below phlebostatic axis,
hypervolemia,
RV failure,
valve stenosis,
pulmonary HTN,
PEEP,
Ventricular septal defect,
Constrictive pericarditis,
cardiac tamponade

Question 20

PAC ports by color

Answer 20

Blue-proximal port(right atrial pressure)
Red-balloon inflation port
Yellow-distal port (pulmonary artery pressure)

Question 21

Swan-Ganz catheters are _______ and not _______ tools.

Answer 21

diagnostic, therapeutic

Question 22

Risk factors for pulmonary artery rupture with PAC

Answer 22

ACs,
hypothermia,
advanced age,
catheter too far,
prolonged ballon inflation, 
chronic irritation of vessel wall,
unrecognized wedging,
filling balloon with liquid ,
PA rupture has 50% mortality rate

Question 23

What zone should the tip of PAC be in?

Answer 23

West zone 3

Question 24

Waveforms of PAOP?

Answer 24

A wave- left atrial systole
C wave- closure of the mitral valve
V wave- filling of the LA

Question 25

What phases of the cardiac cycle are the PAOP waveforms associated with?

Answer 25

A wave-Phase 1 atrial systole
C wave-Phase 3 rapid ejection
V wave-Phase 5 isovolumic relaxation

Question 26

Normal range of Afterload

Answer 26

1760-2600

Question 27

What is afterload?

Answer 27

systolic wall stress or the impedance the ventricle must overcome to eject its stroke volume

Question 28

Normal SvO2

Answer 28

65-77%

Question 29

What is SvO2

Answer 29

the percentage of oxygen bound to hemoglobin in blood returning to the right side of the heart. This refects the amount of oxygen “left over” after the tissues remove what they need.