Cardiac Clinical Monitoring Flashcards
Normal CVP aka MRAP (mean right atrial pressure) range
1-10 mmHG
Where should the CVP line sit in the heart
At the most distal part of the SVC but not in the RA
Normal RV range
15-30 / 0-8 mmhg
25/5 average (quarter over a nickel)
Normal PA range
15-30 / 5-15 mmhg
25/10 average (quarter of a dime)
Normal mean PA range
10-20mmhg
15 avg
Normal PAOP (wedge) range
5-15mmhg
10 avg
Normal LVEDP (left ventricular end-diastolic pressure) range
4-12 mmHg
Avg 8 mmHg
CVP port on PAC is used to estimate?
RVEDP
right ventricular end diastolic pressure
Distal tip of PAC is used to estimate?
RV systolic pressure via the PA systolic reading.
The upstroke of the PA tracing is produced by?
The opening of the pulmonic valve and is followed by RV ejection.
The downstroke of the PA waveform, which contains the dicrotic notch, is produced by?
Sudden closure of the pulmonic valve leaflets (the beginning of diastole)
Similarities and differences between PAOP and CVP waveform/readings
Both have a,c,v waves.
PAOP (5-15) is less likely to see c wave. Waveform as a whole should be at a higher baseline pressure because you are measuring LV pressures.
CVP measurements will be 0-10
PAOP waveform - what do a, c, and v represent
a = LA systole
c = closure of mitral valve
v = filling of LA as well as volume displacement of mitral valve closure during LV systole
The a wave on the cvp will correlate with what EKG event
a wave will follow the P wave (atrial depolarization, contraction)
The c and v wave on the cvp will correlate with what EKG event
the c and v waves occur after the beginning of the ventricular contraction (QRS)
the v wave may not occur until shortly after the T wave
What factors can create giant a waves aka cannon a waves?
Junctional rhythms
complete AV block
PVCs
ventricular pacing asynchronous
tricuspid or mitral stenosis
diastolic dysfunction
myocardial ischemia
ventricular hypertrophy
What are 2 factors that can create large v waves?
Tricuspid or Mitral Regurg
Acute increase in intravascular volume
What are two factors that can cause a loss of a waves or only v waves?
atrial fibrillation
ventricular pacing in the setting of asystole
is the CVP a reliable measurement for fluid volume responsiveness?
No. But it still has value to it, just not for evaluating fluid responsiveness.
What are better measures of fluid responsiveness than CVP?
Dynamic values such as SVV and PPV
stroke volume variant and pressure volume variation
What change in SVV indicates fluid responsiveness
Small volume bolus and assess SVV. If there is less SVV occurs after bolus (ex 17% to 15%) the reduction indicates the patient will respond/require further preload augmentation
What criteria must be met for SVV and PPV measurements to be accurate?
Patients must be mechanically vented with at least 7-6mL/kg tidal volume with no spontaneous respiratory effort and patients must be in sinus rhythm.
In mechanically vented patients, the normal SVV? Above what % implies fluid admin should be given?
range for normal is 10-13%. Values higher than 12-13% imply patients will respond positively to an increase in preload.
Goal PPV range?
10-15%. greater than 12% likely fluid responsive.
Potential causes of elevated CVP
RV failure
Tricuspid stenosis or regurg
Cardiac Tamponade
Constrictive pericarditis
volume overload
Pulm HTN
chronic LV failure
catheter whip
catheter coiling
Potential causes of elevated PAP
LV failure
Mitral stenosis or regurg
L to R Shunt
ASD or VSD
Volume overload
Pulm HTN
“catheter whip”
Potential causes of elevated POAP
LV failure
Mitral stenosis or regurg
Cardiac tamponade
Constrictive pericarditis
volume overload
ischemia
The mean or diastolic PA pressure should always be measured when? Why?
At the end of expiration.
this the time when pleural pressures are most closely equal to atmospheric pressure (except when PEEP is being used)
LVEDP should be measured at what point the PAP recording?
Lowest most point after dicrotic notch. just before the upstroke of the v wave, or c wave if present