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Cardiology > Hemodynamic Monitoring > Flashcards

Hemodynamic Monitoring Flashcards

1
Q

What is the purpose of hemodynamic monitoring?

A

to evaluate the ability of the cardiovascular system to deliver blood flow and oxygenation to the tissues

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2
Q

How many lumens is the Pulmonary Artery Catheter (Swan-Ganz)?

A

4 lumens

  • Proximal Lumen (Blue)
  • Distal Lumen (Yellow)
  • Balloon Inflation Port (Red)
  • Infusion port (White)
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3
Q

How manny mmHg do you want the pressure bag set up at for Pulmonary Artery Catheter?

A

500 cc IV Bag at 300 mmHg

  • Needs to be 300mmHg to overcome the resistance of the flush device in the transducer and deliver 3mL per hour through the catheter
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4
Q

Where is the placement of the transducer?

A
  • Level with the right atrium (Phlebostatic axis)

- 4th intercostal space mid axillary

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5
Q

What is it called when the transducer is calibrated to ambient air pressure?

A

Zeroing

  • Zeroing the transducer tells the monitoring system that the atmospheric pressure is “zero”
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6
Q

What happens if the transducer is lower or higher than the phlebostatic axis?

A

Lower - High Readings

Higher - Low Readings

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7
Q

What can cause LOW hemodynamic monitoring values?

A
  • The Transducer is above the phlebostatic axis
  • Air bubbles
  • Clots in the Catheter
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8
Q

What are the parts of the PAC waveform?

A

A wave - produced when the atrial contract
X and Y wave - produced with atrial diastole
C wave - produced with the closure of the tricuspid valve
V wave - produced with right ventricle contraction

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9
Q

What is CVP?

A

Central Venous Pressure

  • The pressure in the large thoracic vessels
  • Measured by the Blue proximal lumen
  • 2-6 mmHg
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10
Q

What is RAP?

A

Right Atrial Pressure

  • The pressure in the right atria
  • Measured through the proximal port of the PA catheter
  • 4-6 mmHg
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11
Q

What is the difference between the right ventricular pressure (RVP) and the Pulmonary Artery pressure (PAP)?

A

Reflected in the diastolic pressure

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12
Q

What is the process of inserting a PAC?

A

1) Move the catheter through the great vessels to the right atrium where a CVP and RAP will be obtained.
2) Inflate the ballon and guide PAC through to the Right Ventricle where a RVP will be obtained
3) Float the ballon up the Semilunar valve into the Pulmonary Artery where a PAP will be obtained.

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13
Q

What does CVP and RAP show us?

A

Right Ventricular end diastole pressure (Preload)

2 - 6 mmHg

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14
Q

What is Right Ventricular Pressure (RVP)? and what are the normal values?

A

Pressure in the right ventricle at the end of ventricular filling
- seen during insertion

Normal Values:
Systolic: 15 - 30 mmHg
Diastolic: 0 - 8 mmHg

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15
Q

What is Pulmonary Artery Pressure (PAP)? and what are the normal values?

A
  • Reflects both right and left heart pressures
  • Pressure is obtained when the ballon is deflated

Normal Values:
Systolic: 15 - 30 mmHg
Diastolic: 5 - 15 mmHg

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16
Q

What causes Increased PAP?

A
  • Hypervolemia
  • Pulmonary HTN
  • PPV
  • Cardiac Tamponade
  • Left Ventricular Failure
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17
Q

What cause Decreased PAP?

A
  • Hypovolemia

- Vasodilatation

18
Q

What is the Pulmonary Artery Wedge Pressure (PAWP)? and what is the normal values?

  • Also known as PCWP, PAOP, and wedge pressure.
A

Indirectly reflects left atrial pressure and left ventricular end diastolic pressure (LVEDP) (LVP left ventricular preload)

4 - 12 mmHg

  • Measured when the balloon is inflated at the end of expiration
19
Q

True or False

Wedging of the catheter is only done to obtain the wedge pressure.

A

True

20
Q

How much air is the balloon inflated with?

A
  1. 5 cc

- Only air can be used

21
Q

Describe the process that occurs when a wedge pressure is obtained?

A

1) the ballon is inflated with 1.5 cc of air and allowed to wedge into the distal branch of the pulmonary artery, where it is too narrow for the balloon to pass
2) During the occlusion, the catheter sensing tips “see through” the pulmonary circulation (no valves) into the left atrium giving an indirect reflection of the left atrial pressure (LAP)
3) Deflate ballon and passively return to the pulmonary artery

22
Q

How long can the balloon be inflated?

A

No longer than 15 seconds

23
Q

Can you flush the catheter in the wedge position?

A

No

24
Q

After each PCWP reading is it necessary to re-zero and recalibrate the transducer system?

A

Yes

25
Q

Does breathing affect the PAWP?

A

Yes

  • Inspiration - Lowers Pressure
  • Expiration - Raises Pressure
26
Q

What is Cardiac Output (CO)? and what is the normal values?

A

The amount of blood ejected by the ventricle each minute
- Evaluates cardiac function

Normal Range:
4 - 8 L/minute

27
Q

What is Cardiac Index (CI) and what is the normal values?

A

Cardiac Output divided by body surface area (BSA)

Normal Range:
2.5 - 4 L/m/m2

28
Q

What is Mixed SvO2?

A

Mixed Venous Oxygen saturation (SvO2) is the amount of hemoglobin saturated with oxygen

Normal Range:
60 - 80%

29
Q

MAP values?

A

70 -100 mmHg

30
Q

CVP values?

A

2 -6 mmHg

31
Q

PAP values?

A

15 - 30 mmHg (systolic)

32
Q

PAD values?

A

5 - 15 mmHg (diastolic)

33
Q

PCWP values?

A

4 - 12 mmHg

34
Q

CO values?

A

4 - 8 L/min

35
Q

What is systemic vascular resistance (SVR)?

A

Calculated value based on mean arterial pressure and pulmonary wedge pressure
- indicator of left ventricular afterload

Normal Range:
800 - 1200 dynes/sec/cm^5

36
Q

What does it mean if there is a dampened waveform?

A
  • Catheter may have migrated forward (cough or pull back)
  • air or blood in tubing
  • blood in transducer
  • Catheter is kinked

+ attempt to pull the catheter back into the right atrium if catheter has spontaneously migrated forward

37
Q

If your waveform shows what looks to be Ventricular Tachycardia (Saw-toothed) what does that mean?

A

The swan has fallen into the right ventricle

Immediately remove

38
Q

What is Catheter Whip or Fling?

A

movement of the catheter forward during contraction of right ventricle

  • Can create falsely elevated systolic pressures and lowered diastolic pressures
39
Q

What is the most important aspect of hemodynamic monitoring?

A

Stroke Volume

40
Q

What is the constant flow that a PAC must maintain?

A

3 - 5 cc/hr

Cardiology (3 decks)

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