BEDSIDE HEMODYNAMIC MONITORING Flashcards
What is a Swan-Ganz catheter?
A Swan-Ganz catheter is a soft, flexible catheter with an inflatable balloon at its tip used in right-sided heart catheterization.
How many lumens does the most common Swan-Ganz catheter have?
The most common Swan-Ganz catheter has four lumens.
What is the function of the distal port in a Swan-Ganz catheter?
The distal port allows for measurement of pulmonary artery (PA) pressure when the balloon is deflated and pulmonary artery wedge pressure (PAWP) when inflated.
What is measured using the thermocouple in a Swan-Ganz catheter?
Cardiac output (CO) is measured using the temperature-sensing thermocouple.
What can be directly measured with a Swan-Ganz catheter?
Direct measurements include vascular pressures and oxygen saturations, CO, and systemic venous oxygen saturation (SvO2).
How is a Swan-Ganz catheter inserted?
Venous access is obtained by introducing an 8 French sheath into the internal jugular or subclavian vein, followed by passing a 7.5 French Swan-Ganz catheter through the sheath.
What does the a wave in pressure waveforms correspond to?
The a wave is produced by atrial contraction and follows the electrical P wave on ECG.
What indicates that the Swan-Ganz catheter is in the wedge position?
An atrial tracing reflecting left atrial pressure will be seen when the catheter is in the wedge position.
What does the PAWP approximate?
The pulmonary artery wedge pressure (PAWP) approximates left atrial pressure.
How is cardiac output determined using thermodilution?
10 mL of normal saline is injected into the right atrium, causing a drop in temperature that is measured continuously.
What is the Fick method used for?
The Fick method is used to calculate cardiac output based on oxygen consumption and arteriovenous oxygen difference.
What are normal values for right atrial pressure?
Normal values for right atrial pressure are 0–6 mm Hg.
What clinical situations indicate the use of a Swan-Ganz catheter?
Indications include heart failure/shock, acute myocardial infarction, and perioperative management in high-risk patients.
True or False: The Swan-Ganz catheter is indicated for routine management of pulmonary edema.
False
What is pulmonary hypertension defined as?
Pulmonary hypertension (PH) is defined as a mean pulmonary artery pressure ≥20 mm Hg.
Fill in the blank: The Swan-Ganz catheter is primarily used for _______.
right-sided heart catheterization.
What are the normal values for pulmonary artery wedge pressure?
Normal values for pulmonary artery wedge pressure are 6–12 mm Hg.
What can cause discordance between pulmonary capillary wedge pressure and left ventricular end-diastolic pressure?
Common causes include mitral stenosis and pulmonary vein stenosis.
What measurement is indicated by the v wave in pressure waveforms?
The v wave is caused by venous filling of the atrium during ventricular systole.
What is the significance of the area under the curve in thermodilution?
The area under the curve is inversely related to cardiac output.
What does the y descent in pressure waveforms indicate?
The y descent is produced by rapid atrial emptying when the tricuspid valve opens at the onset of diastole.
What is the purpose of fluoroscopy during Swan-Ganz catheter placement?
Fluoroscopy is used to confirm that the catheter is in a distal pulmonary arteriole.
What are the derived hemodynamic parameters from a Swan-Ganz catheter?
Derived parameters include cardiac index, stroke volume index, and vascular resistances.
What is a major randomized trial regarding Swan-Ganz catheters in heart failure patients?
The ESCAPE trial showed no significant difference in mortality and days out of hospital at 6 months.
