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Anesthesia Principles 1 > CVP and PA monitoring > Flashcards

CVP and PA monitoring Flashcards

1
Q

Where should the tip of the CVP catheter rest?

A

Just above the junction of the Vena Cava and the Right Atrium

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2
Q

Where should the tip of the PA catheter reside?

A

In the pulmonary artery, distal to the pulmonary valve (25-35 cm from the VC junction)

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3
Q

Highest risk of injuring the thoracic duct (chylothorax)?

A

Accessing the Left I J

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4
Q

Most common complication while obtaining access?

A

Dysrhythmias

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5
Q

Presentation of pulmonary artery rupture?

A

Hemoptysis

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6
Q

When should you not float a PA catheter on a patient?

A

LBBB (can cause complete HEART BLOCK)

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7
Q

RIJ to VC and RA junction

A

15 cm

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8
Q

LIJ to VC and RA junction

A

20 cm

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9
Q

Median basilic

A

Right: 40 cm
Left: 50 cm

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10
Q

Subclavian (either side)

A

10 cm

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11
Q

RA (PA)

A

0-10 cm

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12
Q

RV (PA)

A

10-15 cm

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13
Q

Pulmonary Artery (catheter tip cm)

A

15-30 cm

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14
Q

PAOP position (tip)

A

25-35 cm

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15
Q

RA contraction

A

a wave
(just after P wave (atrial depolarization)

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16
Q

Tricuspid valve elevation into the RA

A

c wave
(just after QRS complex, ventricular depolarization)

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17
Q

Downward movement of the contracting RV

A

X descent (ST segment)

18
Q

Passive filling of the RA

A

v wave
(just after T wave begins, ventricular depolarization)

19
Q

RA empties through the open tricuspid valve

A

Y descent
(after T wave ends)

20
Q

Normal CVP in an adult?

A

1-10 mmHg

21
Q

Hypervolemia, tricuspid stenosis/regurg, pulmonary HTN, cardiac tamponade, PEEP, RV failure, transducer BELOW phlebostatic axis (effect on CVP?)

A

Factors that INCREASE CVP

22
Q

Low CVP is almost always caused by:

A

Hypovolemia or the transducer is moved ABOVE the zero point

23
Q

CVP should be zeroed at:

A

The phlebostatic axis (4th intercostal space mid anterorposterior level)

24
Q

A transducer placed below the zero point does what?

A

OVERestimates CVP

25
Q

CVP should be measured at….

A

END-EXPIRATION

26
Q

CVP is a function of:

A
  1. Intravascular volume
  2. Venous tone
  3. RV compliance
27
Q

Causes of LOSS of A-wave?

A

A-fib and V-pacing in asystole

28
Q

Causes of LARGE a-wave

A

tricuspid stenosis, diastolic dysfunction, AV dissociation

29
Q

Causes of large V-wave

A

tricuspid regurgitation and RV papillary muscle ischemia and acute increase of intravascular volume

30
Q

What happens when tip of PA catheter moves beyond pulmonic valve?

A

Diastolic pressure RISES

31
Q

Waveforms in PAOP (wedge) Pressure

A

a wave: caused by LA systole
c wave: mitral valve elevation into LA during LV systole
v wave: caused by passive LA filling

32
Q

Normal pressures of PA catheter measurement

A

RA: 1-10 mmHg
RV: systolic 15-30, diastolic 0-8 mmHg
PAP: systolic 15-30, diastolic 5-15 mmHg
PAOP: 5-15 mmHg

33
Q

Aortic valve insufficiency causes PAOP to….

A

UNDERESTIMATE LVEDV

34
Q

PAOP OVERestimates LVEDP

A

MVR/stenosis, left-to-right cardiac shunt, tachycardia, PEEP, COPD, pulmonary HTN

35
Q

Which lung zone should the tip of pulmonary artery catheter be placed?

A

Zone 3

36
Q

Thermodilution Underestimates CO

A

Injectate volume too HIGH
Injectate solution too COLD

37
Q

Thermodilution Overestimates CO

A

injectate volume too LOW
injectate solution too HOT
partially wedged PAC
Thrombus on tip of PAC

38
Q

Unable to predict CO

A

Intracardiac Shunt
Tricuspid Regurgitation

39
Q

4 variables mixed venous oxygen is dependent on?

A
  1. CO
  2. O2 consumption
  3. Hgb
  4. Hemoglobin saturation
40
Q

Factors that DECREASE SvO2?

A

Increased O2 consumption: stress, pain, thyroid storm, shivering, fever
Decreased O2 delivery: decreased SaO2, Hgb, or CO

41
Q

Factors that DECREASE SvO2?

A

Decreased O2 consumption: hypothermia, cyanide toxicity
Increased O2 delivery: O2 therapy, increased Hgb, CO

42
Q
A

Anesthesia Principles 1 (11 decks)

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