CVP and PA-C Flashcards
what location of catheter placement is the shortest and straightest path to the heart
RIJ
what is the proximal port used for
measures RAP and CVP. used for med infusion and to bolus CO measurements
what is the distal port used for
measures PA pressure and wedge pressure when balloon is inflated
where is CVP leveled to?
4th intercostal space at midaxillary line
when in resp cycle should you measure CVP
end-expiration
where should distal tip of central line lie
junction of VC and RA
a wave
right atrial contraction
c wave
right ventricular contraction - bulging of tricuspid into RA.
v wave
passive filling of RA
a wave in accordance with the ekg
just after p wave
c wave in accordance with ekg
just after QRS (ventricular depolarization)
v wave
passive filling of RA
v wave in accordance with ekg
just after T-wave begins (ventricular repolarization)
x descent
RA relaxation
x descent in accordance with ekg
ST segment
y descent
RA empties thru open tricuspid valve
loss of a waves or only v waves caused by
loss of atrial kick. A-fib. ventricular pacing in the setting of asystole.
large v waves
high amplitude during ventricular contraction. tricuspid or mitral regurg. acute increase in intravascular volume. ventricular failure. increased PVR and SVR and ventricular septal defect.
giant a waves
junctional rhythms
- complete AV block
- PVC’s (simultaneous atrial and ventricular contraction)
- ventricular pacing (asynchronous)
- tricuspid or mitral stenosis
- diastolic dysfunction
- myocardial ischemia
- ventricular hypertrophy
x descent in the PAWP tracing
L atrial relaxation
y descent in the PAWP tracing
L atrial emptying associated with the opening of MV. onset of LV diastole.
A wave in PAWP tracing
LA systole
C wave in pawp
closure of mitral
V wave in pawp
filling of LA, as well as upward displacement of the mitral valve during LV systole
normal range CI
2.6-4.2
normal CO
5-6 L/min
anrep
abrupt increase in afterload can cause a modest increase in inotropy
tripe (bowditch) effect)
when HR is elevated, Ca doesnt have time to completely leave the cell. This increases amt of Ca sitting on actin and myocin causes a stronger squeeze increases contractility with high HR
SV =
EDV - ESV
how does parasympathetic innervation affect inotropy
decreases
normal SVR
900-1200
normal SVRI
1760-2600
normal PVR
100-200
normal PVRI
225-285
RAP
1-10
RVP
15-30 / 0-8
PAP
15-30 / 5-15
PAOP
5-15
PEEP of 10 usually results in increase of CVP by
3
causes of high CVP
RV failure, cardiac tamponade, constrictive pericarditis
what is the usual feature of the PA waveform and what does it represent
dicrotic notch, represents aortic valve closure
systolic PA pressure represents
pressure in the PA as blood is being ejected from the RV
diastolic PA pressure represents
pressure in the PA as blood moves from the artery into the lungs capillaries
the upstroke of the PA tracing is produced by opening of the
pulmonic valve
the downstroke of the PA tracing contains the
dicrotic notch, produced by sudden closure of the pulmonic valve leaflets (the beginning of diastole)
west zone 3 pressures
pa > pv > PA
big A is
alveolar
zone 2 pressures
pa >pA >pv
zone 1 pressures
PA > pa >Pv
when PVR is used clinically it should be viewed as a gross estimate of
RV afterload
increase in venous pressure ____ preload
increases
greater compliance leads to ___ filling and ___ preload
greater, greater
HR and ventricular filling are ____ related
inversely
hypervolemia, regurgitate of cardiac valves, and heart failure ___ preload
increase
increase in outflow resistance (pulmonic valve stenosis, pulm htn) ____ ventricular emptying, actually ____ preload
impairs, increases
when inotropy decreases (ventricular systolic failure), preload
increases
what is the primary determinant of SVR
arteriolar tone
SVR is increased by
sympathetic activation, hypovolemia, shock
SVR is decreased by
septic shock, parasympathetic, hypercarbia
what does it mean if PVR Is high
RV must work harder to move blood forward past the pulmonic valve
at low lung volumes, compression of the extra alveolar vessels
increases PVR.
the lease amt of resistance in the pulm system happens at
FRC
what does hypoxemia do to PVR
increases
what does acidemia do to PVR
increase
what does hypercapnia do to PVR
increases
what does hypovolemia do to PVR
increases
what does hyperinflation do to PVR (increased PEEP, increased PIP)
increases
what does sympathetic stimulation do to PVR
increases
what does a high HCT do to PVR
increases
what does strenuous exercise do to PVR
decrease
what does neo do to PVR
increase (same with constrictors)
what does nitric oxide to do PVR
decrease (same with other dilators)
increased PVR is caused by ___ PAO2, ___ PCO2, ___ph
decreased, increased, decreased
SVO2 is the measurement of the relationship between
o2 consumption and O2 delivery
fick equation
SVO2 = SAO2 - [VO2)/(hb x 1.36 x Q)]
a high injectate volume ___ CO
under estimates
a low injectate volume ___ CO
over estimates
if injectate is too warm, ___ CO
over estimates
if partially wedged, ___ CO
over estimates
if CO is high, injectate moves
quickly. low AUC
if CO is low , injectate moves
slowly. high AUC
if injactate is too cold
underestimates CO
if injectate is too warm
overestimates CO
unable to predict CO with thermodiluation if
r to L cardiac shunt. tricuspid regurg
