Ch 9 PA pressure monitoring Flashcards
CVP =
Right Heart Filling Pressures
LVEDP =
Left Heart Filling Pressures
Left atrial pressure waveforms have essentially the same form as what?
right atrial waveforms
PROBLEM: It is physically difficult to insert a catheter for the measurement of _____ ?
left atrial pressure.
A catheter fitted with an inflatable balloon (Swan Ganz catheter) is passed from a
vein, through the right side of the heart into the pulmonary artery.
With the balloon inflated the catheter is allowed to wedge into a pulmonary arterial side branch. Once wedged (there is zero flow in the pulmonary artery which is wedged) the pressure recorded via this catheter reflects the left atrial pressure, albeit giving a damped (smoothed) pressure waveform.
left atrial pressure, albeit or although giving a damped (smoothed) pressure waveform.
Nevertheless this pressure, termed the pulmonary artery wedge pressure (PAWP) or the pulmonary artery occlusion pressure, provides what ?
mean left atrial pressure values comparable to those measured in the left atrium.
PA catheter insertion steps?
IJ, SVC, RA, Tricuspid valve, RV, Pulmonic valve, and finally the PA.
On the PAWP waveform, what are the wave points in order?
a, x , v, and y
On the PAWP waveform, what does the “a” wave represent? what it a normal value?
Atrial Contraction
4-15 mmHg
On the PAWP waveform, what does the “x” wave represent?
Atrial Diastole
On the PAWP waveform, what does the “v” wave represent? What it a normal value?
Passive Atrial Filling
4 - 15 mmHg
On the PAWP waveform, what does the “y” wave represent?
Atrial Emptying
What can cause a confusing PA pressure and PAWP?
Mitral Valve Insufficiency
What are the Indications Pulmonary artery catheterization ?
√ Acute MI with hemodynamic instability √ Severe hypotension of unknown etiology, specially if the response to initial therapy is inadequate (eg, volume loading) √ selected cases of septic shock √ ARDS, to confirm the diagnosis of noncardiogenic √ pulmonary edema (normal "wedge" pressure) and to aid in subsequent fluid and ventilator management
CVP should correlate with what pressure ?
PA
Indications Pulmonary artery catheterization continued. .
√ poss cardiac tamponade,
√ suspected papillary muscle rupture
√ poss VSD or ASD post MI
√ CHF responding poorly to diuretics, especially when intravascular volume status is uncertain
√ intraoperative monitoring of patients undergoing open heart surgery, particularly coronary artery bypass procedures involving multiple vessels; patients undergoing AAA repair may also benefit from PA catheterization perioperatively
ASD
Atrial Septal Defect
VSD
Ventricular Septal Defect
Swan-Ganz catheterization may also be useful in the following scenarios:
√ heroin, aspirin OD
√ exacerbations of COPD requiring intubation; hemodynamic monitoring may detect occult or
√ superimposed causes of respiratory failure not suspected clinically (eg, left ventricular dysfunction)
√ end-stage liver failure with deteriorating renal function
√ suspected cases of pulmonary hypertension
Contraindications for Swan-Ganz catheterization ?
- Severe, uncorrectable coagulopathy
- LBBB
- local infection at the skin
insertion site - severe hypothermia
- inadequate monitoring equipment
- patient refusal
If an underlying LBBB is present during placement of a right heart catheter may lead to what ?
complete heart block (A-V dissociation)
Severe hypothermia during placement of a right heart catheter may lead to what ?
malignant arrhythmias induced by the catheter due to the myocardium being highly irritable.
Would you insert a PA catheter in a patient who overdose with heroin or ASA?
No, the risk of acute lung damage is very high, this would cause enough bleeding for the patient to drown with their own blood.