CVP and PAC

Question 1

Indications for a central line

Answer 1

• monitor CVP pressure
• administer medications
• nutrition
• blood draws

Question 2

Who should get a CVP/ PAC?

Answer 2

• Cardiac
  
  • recent MI
  • complications of MI
  • Poor LV function
• Non-cardiac
  
  • shock
  • severe pulmonary disease
  • massive trauma
  • complicated surgical procedures

Question 3

What are indications for a PAC?

Answer 3

• Monitoring hemodynamic instability
• Monitor pressure to titrate vasoactive medication dose
• collection of mixed venous blood gas sample

Question 4

What are the common insertions sites of a CVP line/PAC?

Answer 4

• Subclavian
• jugular
• femoral vein

Question 5

From this image where is the tip of the catheter and what are the related pressures?

Answer 5

• RA: 2-6mmHg
• RV pressure: systolic 20-30, diastolic 2-6
• PA pressure: systolic 20-30, diastolic 6-16
• PAWP pressure: 4-12 mmHg

Question 6

Where does a Central venous catheter sit and what does it measure?

Answer 6

• Sits at the top of the right atrium
• measures CVP(RV preload)
• Right heart function and evaluates fluid status

Question 7

What are other names for a pulmonary artery catheter (PAC)? what can it measure and what does it assess?

Answer 7

• Swan-Ganz or Balloon tipped directed flow catheter
• Pulmonary artery pressure-right ventricular afterload
• Wedge pressure- left ventricular preload
• CVP pressure- right ventricular preload

Question 8

What things can influence the CVP?

Answer 8

• intravascular volume
• PVR
• R heart function
• intrathoracic pressure

Question 9

What things cause a Low CVP? high CVP?

Answer 9

• high
  
  • Right heart dz
  • lung dz
  • high thoracic pressure
  • hypervolemia
• Low
  
  • hypovolemia

Question 10

What is damping? what does it mean if something is over or under damped?

Answer 10

• how quickly the system returns to normal following a pressure change
• optimal 1-2 oscillations

Overdamped- not enough

• clot formation
• large air bubbles
• loose connections or leaks

Underdamped- too many oscillations- often catheter whip

Question 12

What are the normals for PAP?

what is it influenced by?

Answer 12

• Normal PAP
  
  • Systolic: 20-30
  • Diastolic: 6-12
  • Mean: 10-20
• Influenced by:
  
  • Intravascular volume (hypo or hypervolemia)
  • PVR (Pulm HTN, lung dz, hypoxia, edema, embolus)
  • Left heart function (L sided MI, mitral or aortic valve dysfunction)
  • Intrathoracic pressure (tension pneumo, PPV)
• High PAP:
  
  • Lung dz
  • L heart dz
  • high thoracic pressure
  • hypervolemia
• Low PAP
  
  • Hypovolemia