Hemodynamic review part 3

Question 1

Which type of line would a very complex patient use?

Answer 1

Pulmonary Artery/Swanz

Question 2

What can a PA/Swanz line measure?

Answer 2

Stroke volume
CO/CI
PA pressure
SVR, PVR
SVo2

Question 3

What part of the pulmonary artery catheter is used to find a wedge pressure?

Answer 3

You float the distal lumen port with a balloon, and you inflate the balloon with the proper syringe.

Question 4

What is PAD a measurement of ?

Answer 4

It is a measurement of the lungs while relaxed. Pulmonary artery diastolic

Question 5

Why use a PA/Swanz?

Answer 5

Hemodynamic monitoring is continuous

Easy to place

Standard hemodynamic tool

Question 6

Why wouldn’t we use a PA/Swanz?

Answer 6

Invasiveness means it can be harmful due to infection, perforation, and can be interpreted wrong

It has never been shown to demonstrate clinical benefit

Requires training to interpret waveforms

Requires knowledge and continuous nursing care

Question 7

Indications to use Swan-Ganz

Answer 7

Post MI

Cardiac Surgery

Shock

Pulmonary edema

Oxygen transport with ventilation and perfusion

Question 8

How long do you inflate the balloon on a PA for a PAWP reading?

How much fluid do you use?

Answer 8

Inflate the balloon until the waveform changes

• no more than 8 to 15 seconds
• Four respiratory cycles

Use the 1-1.5 mLs

• if it wedges with less, than it could be too far in. YOU ARE NOT ALLOWED TO TOUCH IT

Question 9

What can you do if you feel as though the balloon has migrated back for a PA?

Answer 9

Put the patient on the left side

Question 10

Increased PA

Increased PAWP

Answer 10

left sided heart failure - crackles, pink froth, JVD, leg edema

Question 11

Increased PA

Normal PAWP

Answer 11

Pulmonary disease

Question 12

Decreased PA

Answer 12

low volume

(check if CVP is low, BP low, UO low, and SVR low?)

Question 13

Decreased PAWP

Answer 13

Fluid volume deficit

Question 14

Increased PAWP

Answer 14

FLuid overload

Left ventricular failure

Question 15

Besides CVP, what other measurements tell us about fluid status?

Answer 15

CVP and Wedge pressure can tell us.

Low PAWP = fluid volume deficit

High PAWP = fluid overload , left ventricular failure

Question 16

What does PAWP measurement for a PA/Swanz indicate?

Answer 16

Reflects the preload of the left side of the heart (not the right like cvp)

Question 17

What drug can cause a decrease in SVR?

What conditions can cause the SVR to decrease?

Answer 17

Nipride drops SVR due to it causing vasodilation

Shock states which are pretty much vasodilation states cause the SVR to drop as well

Question 18

What can cause an increased SVR?

Answer 18

Vasoconstriction itself which can be caused by hypovolemia or vasoactive agents

• norepinephrine, phenylephrine, epinephrine, and vasopressin, dopamine

Question 19

How does the PA/SWanz measure the cardiac output?

What is the normal range?

Answer 19

Heat signals are produced from electrical impulses - so any change in temp is measured by the thermistor which calculates CO for past 3-5 minutes

Normal range is 4-8 L/min

Question 20

What is a low SV indicated of?

What is the norm?

Answer 20

Low SV means poor ventricular performance

Norm is 60-100 mL/min

Question 21

What is SVV?

What if it greater than 15%?

Answer 21

Stroke volume variance - used with ventilated patients who are on PEEP (arterial pulsations)

Greater than 15% indicates hypovolemia (bc high is dry in this case ) (opposite of CVP)

Question 22

Complications to watch for with the PA/Swanz line

Answer 22

Infection and sepsis

Air embolus(due to disconnection)

Ventricular dysthymia

PA catheter may not be wedged

Question 23

How do we deal with infection and sepsis with PA catheter?

Answer 23

Change flush bag, pressure tubing, transducer, and stopcock every 96 hours

Question 24

When do the ventricular dysrhythmias occur with a PA/Swanz?

What is an intervention you can do to fix it?

Answer 24

When the tip migrates back from PA to Right ventricle. Try to reposition them on the left side. Then call the physician.

Question 25

What do you do if a PA catheter isn’t able to be wedged ?

Answer 25

May need repositioning. Put on left side.

Question 26

When using a PA/Swanz you know a pulmonary infarction or pulmonary rupture can occur. Why is this?

Answer 26

Overinflation if you use the wrong syringe

Prolonged inflation if you leave it inflated for too long

Spontaneous wedging

A thrombus can form.

Question 27

What plugs go on the stopcock ports?

Answer 27

Deadenders or luer locks. Make sure to change them. (96 hours?)

red= arteries

blue = veins

Question 28

Before inserting PA/swanz you need to grab baseline data. What does this include?

Answer 28

General appearance

LOC
Skin color and temp

Vital signs

Peripheral pulses

Urine output

Do this so we can compare the assessment

Question 29

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