CVP and PA Catheter

Question 1

What are the indications for a PA Catheter?

Answer 1

Hemodynamically Unstable Patient
Cardiogenic Shock - Sepsis patients
Management of Post Cardiac Surgery Patients

Question 2

Complications of PA Catheter

Answer 2

usual complications of central line insertion
arrhythmias
heart block (6% RBBB -> beware if patient already has LBBB!)
infection
knotting
pulmonary infarction
hypotension
hypoxia
PA rupture
air embolism
LATE:
thrombosis
pulmonary artery rupture (see Pulmonary haemorrhage after PAOP measurement)
line sepsis
endocarditis
inability to remove (e.g. due to knotting)

Question 3

What is the Distal Port of the Pa Catherter used for? Yellow

Answer 3

monitor Pulmonary Artery Pressures

Draw Mixed Veinous Blood

Question 4

What is the Proximal Port of the PA catherter for? Blue

Answer 4

Its used to inject cold solution to measure CO

It can also be used to measure CVP and right atrial pressures.

Question 5

What is the White proximal port for?

Answer 5

Use for infusing drugs and fluid

Question 6

What is are the sites of insertion of a PA catheter in the order of best site to least favorite

Answer 6

RIJ 
LSCV  
RSCV  
LIJ 
(can also insert femorally)

Question 7

What are some important points about the PA balloon?

Answer 7

Fill only to about 1.5ml
Balloon Should be deflated passively
when removing syringe from balloon, disconnect syringe and dispell all air and reattach.
WEDGING SHOULDNT BE LONGER THEN 4 BREATH CYCLES

Question 8

What can you do to ensure correct pressures from a PA Catheter?

Answer 8

Zero the sensor

keep it at the phlebostatic axis

Question 9

Indications for a CVP?

Answer 9

IV access (especially if difficult peripheral access)

(2) CVP monitoring
(3) ScvO2 monitoring/sampling
(4) Infusions of irritant substances (e.g. vasoactive agents, chemotherapy or TPN administration)
(5) Renal replacement therapy, olasmapheresis and apheresis
(6) Transvenous pacing