CVP, PAC, A line-complications and waveforms Flashcards
In a patient with Raynaud’s-how do you feel about A lines/
I’d rather not do them, but if it must be done a thorough discussion with the patient must be had regarding risks and benefits, and if it must absolutely be done-prefer larger artery
Indications for CVP:
Normal CVP
CVP monitoring
Transvenous cardiac pacing
HD
Pressors
Normal CVP: 0-8
Possible complications of CVP:
mechanical injury
respiratory compromise due to hematoma or PTX
arrhythmias
A wave means: CVP waveform
end diastole; atrial contraction
C wave: CVP waveform
Tricuspid contraction
V wave: CVP waveform
late systole; systolic filling of the atrium
X descent: CVP waveform
RV contraction, pulling tricuspid valve with it
Y descent: (CVP waveform)
early diastole; early ventricular filling
Loss of a wave means:
Cannon A wave: (CVP waveform)
Loss of a wave: atrial fibrillation/a flutter
Cannon A wave: right ventricular hypertrophy, tricuspid/pulmonary stenosis
What does it mean if you have a tall systolic Cv (or just tall V wave) wave and loss of x descent? (CVP waveform)
Tricuspid regurgitation
Tricuspid stenosis on CVP waveform:
tall a wave and attenuated y descent
Right ventricular ischemia and pericardial constriction on CVP waveform:
Tall a and v waves, steep x and y descent and M or W configuration
Cardiac tamponade on CVP waveform:
dominant x descent and attenuated y descent
Why would you ever place a PAC?
Normal PCWP
CO/CI
PCWP-normally 6-12
Calculation of mixed venous oxygen saturation
Low EF, left sided valvular disease
Complications of PAC:
arterial puncture arrhythmias right bundle branch block complete heart block v fib Pulmonary artery rupture
PAC waveform mitral regurgitation:
tall regurgitant c-v wave and obliteration of x descent
VSD on PAC waveform:
tall anterograde v wave
Mitral stenosis on PAC waveform:
tall a wave and attenuation of y descent
Myocardial ischemia PAC waveform
tall a and v waves
Large A waves on PAC
mitral stenosis, mi, acute CHF
Large V waves on PAC:
mitral regurgitation, CHF, CHF (maybe not acute)
Things that increase chances of pulmonary artery rupture:
Hallmark of PA rupture
pulmonary HTN, hypothermia, anticoagulation
Hallmark is Hemoptysis
How to treat PA rupture:
stabilize cardio/respiratory condition
Intubation can happen with double lumen ETT
PEEP to affected lung
Stop bleeding-reverse AC-unless on bypass, bronchial blocker possibly
as far as removing it-controversial, but i would leave it
