Hemodynamic Monitoring Flashcards
Swan-Ganz Catheter
Used to measure how much pressure blood is under when it goes into the pulmonary artery. Measurements of right heart afterload and left heart preload. PAC and Swann utilize same site (subclavian).
Swan-Ganz Important Notes
- distal tip used to measure pressures
- Do not exceed 1.5cc air in distal cuff
- Do not take wedge pressure readings for >15sec or 3 breaths
- Take readings at end of exhalation
- PA port only for monitoring/lab sample draw
- Deflate balloon during transport - prevents inadvertant wedge
Swan-Ganz Pressure Readings
- PAWP - Pulmonary Artery Wedge Pressure
- PAOP - Pulmonary Artery Occlusion Pressure
- PACP - Pulmonary Artery Capillary Pressure
Swan-Ganz Progression
- Subclavian to right atrium
- Passing into right ventricle
- Final destinationn pulmonary artery
Central Venous Pressure (CVP)
- Right atrial pressure
- Measures right heart preload
- Normal = 2-6mmHg
Right Ventricular Pressure (RV)
- 15-25mmHg systolic
- 0-5mmHg diastolic
- May or my not have a dicrotic notch on left
- High amplitude
Pulmonary Artery Pressure (PA)
- 15-25mmHg systolic
- 8-15mmHg diastolic
- Dicrotic notch on the right side
- High amplitude
Pulmonary Artery Wedge Pressure (PAWP)
- Measures right heart afterload
- Measures left heart preload
- 8-12mmHg
- Low amplitude rolling waveform
Coronary Perfusion Pressure (CPP)
DBP - PCWP
50-60mmHg
Catheter Whip
- If this shows, catheter needs to be floated from the RV into the PA or it could cause V-Fib
- Inflate cuff wth 1.55cc air
- Have the patient cough
- Lay them on their side
Increased PA Pressure
- Left ventricular failure
- Liver failure (portal HTN)
- Cor pulmonale (increased pulmonary vascular resistance)
- Mitral regurgitation
- Mitral stenosis
Cardiac Output Transducer
Hooked up to the Swan-Ganz catheter. Placed at the phlebostatic axis.
Phlebostatic Axis
4th ICS, mid-axillary line
Overdamping
- System is not dynamic
- Kinked line
- Obstruction in the tube
Underdamping
- System is too dynamic
- Pressure bag not full
- Air in the line
Intra-Aortic Balloon Pump (IABP)
- Indications - acute MI with cardiogenic shock post CABG
- CI - aortic insufficiency/disease, severed peripheral vascular disease, aortic regurgitation
- Can cause hemolysis, balloon breaks RBCs during inflation
- Increases coronary perfusion, decreases workload
Cardiogenic Shock
- PAWP > 18-20
- Decreased UOP
- SBP < 80mmHg
IABP Function
- Timed off EKG or manual
- Systole - Deflated
- Diastole - Inflated
IABP Placement
- Femoral artery towards the heart
- Sits in the descending aorta, distal to left subclavian, above renal artery
- Check placement: Left radial pulse (no pulse - left subclavian blocked), UOP (if decreased - blocking renal artery)
- CXR confirmation
IABP Pearls
- Power failure - manual pump q3-5min to prevent clotting
- No need to purge when going to altitude
- Ensure you have extra helium
- Brown/rust colored flakes in tubing indicates rupture of tubing
IABP Late Deflation
Most Dangerous
Increased Afterload
Late Deflation = Lethal Dose
IABP Early Inflation
Dangerous
Causes aortic regurgitation
IABP Late Inflation
Causes sub-optimal coronary perfusion
IABP Early Deflation
Causes retrograde coronary blood flow
