Hemodynamic Monitoring

Question 1

Swan-Ganz Catheter

Answer 1

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).

Question 2

Swan-Ganz Important Notes

Answer 2

• 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

Question 3

Swan-Ganz Pressure Readings

Answer 3

• PAWP - Pulmonary Artery Wedge Pressure
• PAOP - Pulmonary Artery Occlusion Pressure
• PACP - Pulmonary Artery Capillary Pressure

Question 4

Swan-Ganz Progression

Answer 4

1. Subclavian to right atrium
2. Passing into right ventricle
3. Final destinationn pulmonary artery

Question 5

Central Venous Pressure (CVP)

Answer 5

• Right atrial pressure
• Measures right heart preload
• Normal = 2-6mmHg

Question 6

Right Ventricular Pressure (RV)

Answer 6

• 15-25mmHg systolic
• 0-5mmHg diastolic
• May or my not have a dicrotic notch on left
• High amplitude

Question 7

Pulmonary Artery Pressure (PA)

Answer 7

• 15-25mmHg systolic
• 8-15mmHg diastolic
• Dicrotic notch on the right side
• High amplitude

Question 8

Pulmonary Artery Wedge Pressure (PAWP)

Answer 8

• Measures right heart afterload
• Measures left heart preload
• 8-12mmHg
• Low amplitude rolling waveform

Question 9

Coronary Perfusion Pressure (CPP)

Answer 9

DBP - PCWP

50-60mmHg

Question 10

Catheter Whip

Answer 10

• 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

Question 11

Increased PA Pressure

Answer 11

• Left ventricular failure
• Liver failure (portal HTN)
• Cor pulmonale (increased pulmonary vascular resistance)
• Mitral regurgitation
• Mitral stenosis

Question 12

Cardiac Output Transducer

Answer 12

Hooked up to the Swan-Ganz catheter. Placed at the phlebostatic axis.

Question 13

Phlebostatic Axis

Answer 13

4th ICS, mid-axillary line

Question 14

Overdamping

Answer 14

• System is not dynamic
• Kinked line
• Obstruction in the tube

Question 15

Underdamping

Answer 15

• System is too dynamic
• Pressure bag not full
• Air in the line

Question 16

Intra-Aortic Balloon Pump (IABP)

Answer 16

• 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

Question 17

Cardiogenic Shock

Answer 17

• PAWP > 18-20
• Decreased UOP
• SBP < 80mmHg

Question 18

IABP Function

Answer 18

• Timed off EKG or manual
• Systole - Deflated
• Diastole - Inflated

Question 19

IABP Placement

Answer 19

• 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

Question 20

IABP Pearls

Answer 20

• 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

Question 21

IABP Late Deflation

Answer 21

Most Dangerous

Increased Afterload

Late Deflation = Lethal Dose

Question 22

IABP Early Inflation

Answer 22

Dangerous

Causes aortic regurgitation

Question 23

IABP Late Inflation

Answer 23

Causes sub-optimal coronary perfusion

Question 24

IABP Early Deflation

Answer 24

Causes retrograde coronary blood flow