CVP and PA monitoring Flashcards
Where should the tip of the CVP catheter rest?
Just above the junction of the Vena Cava and the Right Atrium
Where should the tip of the PA catheter reside?
In the pulmonary artery, distal to the pulmonary valve (25-35 cm from the VC junction)
Highest risk of injuring the thoracic duct (chylothorax)?
Accessing the Left I J
Most common complication while obtaining access?
Dysrhythmias
Presentation of pulmonary artery rupture?
Hemoptysis
When should you not float a PA catheter on a patient?
LBBB (can cause complete HEART BLOCK)
RIJ to VC and RA junction
15 cm
LIJ to VC and RA junction
20 cm
Median basilic
Right: 40 cm
Left: 50 cm
Subclavian (either side)
10 cm
RA (PA)
0-10 cm
RV (PA)
10-15 cm
Pulmonary Artery (catheter tip cm)
15-30 cm
PAOP position (tip)
25-35 cm
RA contraction
a wave
(just after P wave (atrial depolarization)
Tricuspid valve elevation into the RA
c wave
(just after QRS complex, ventricular depolarization)
Downward movement of the contracting RV
X descent (ST segment)
Passive filling of the RA
v wave
(just after T wave begins, ventricular depolarization)
RA empties through the open tricuspid valve
Y descent
(after T wave ends)
Normal CVP in an adult?
1-10 mmHg
Hypervolemia, tricuspid stenosis/regurg, pulmonary HTN, cardiac tamponade, PEEP, RV failure, transducer BELOW phlebostatic axis (effect on CVP?)
Factors that INCREASE CVP
Low CVP is almost always caused by:
Hypovolemia or the transducer is moved ABOVE the zero point
CVP should be zeroed at:
The phlebostatic axis (4th intercostal space mid anterorposterior level)
A transducer placed below the zero point does what?
OVERestimates CVP
CVP should be measured at….
END-EXPIRATION
CVP is a function of:
- Intravascular volume
- Venous tone
- RV compliance
Causes of LOSS of A-wave?
A-fib and V-pacing in asystole
Causes of LARGE a-wave
tricuspid stenosis, diastolic dysfunction, AV dissociation
Causes of large V-wave
tricuspid regurgitation and RV papillary muscle ischemia and acute increase of intravascular volume
What happens when tip of PA catheter moves beyond pulmonic valve?
Diastolic pressure RISES
Waveforms in PAOP (wedge) Pressure
a wave: caused by LA systole
c wave: mitral valve elevation into LA during LV systole
v wave: caused by passive LA filling
Normal pressures of PA catheter measurement
RA: 1-10 mmHg
RV: systolic 15-30, diastolic 0-8 mmHg
PAP: systolic 15-30, diastolic 5-15 mmHg
PAOP: 5-15 mmHg
Aortic valve insufficiency causes PAOP to….
UNDERESTIMATE LVEDV
PAOP OVERestimates LVEDP
MVR/stenosis, left-to-right cardiac shunt, tachycardia, PEEP, COPD, pulmonary HTN
Which lung zone should the tip of pulmonary artery catheter be placed?
Zone 3
Thermodilution Underestimates CO
Injectate volume too HIGH
Injectate solution too COLD
Thermodilution Overestimates CO
injectate volume too LOW
injectate solution too HOT
partially wedged PAC
Thrombus on tip of PAC
Unable to predict CO
Intracardiac Shunt
Tricuspid Regurgitation
4 variables mixed venous oxygen is dependent on?
- CO
- O2 consumption
- Hgb
- Hemoglobin saturation
Factors that DECREASE SvO2?
Increased O2 consumption: stress, pain, thyroid storm, shivering, fever
Decreased O2 delivery: decreased SaO2, Hgb, or CO
Factors that DECREASE SvO2?
Decreased O2 consumption: hypothermia, cyanide toxicity
Increased O2 delivery: O2 therapy, increased Hgb, CO
