Hemodynamic review part 3 Flashcards
Which type of line would a very complex patient use?
Pulmonary Artery/Swanz
What can a PA/Swanz line measure?
Stroke volume
CO/CI
PA pressure
SVR, PVR
SVo2
What part of the pulmonary artery catheter is used to find a wedge pressure?
You float the distal lumen port with a balloon, and you inflate the balloon with the proper syringe.
What is PAD a measurement of ?
It is a measurement of the lungs while relaxed. Pulmonary artery diastolic
Why use a PA/Swanz?
Hemodynamic monitoring is continuous
Easy to place
Standard hemodynamic tool
Why wouldn’t we use a PA/Swanz?
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
Indications to use Swan-Ganz
Post MI
Cardiac Surgery
Shock
Pulmonary edema
Oxygen transport with ventilation and perfusion
How long do you inflate the balloon on a PA for a PAWP reading?
How much fluid do you use?
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
What can you do if you feel as though the balloon has migrated back for a PA?
Put the patient on the left side
Increased PA
Increased PAWP
left sided heart failure - crackles, pink froth, JVD, leg edema
Increased PA
Normal PAWP
Pulmonary disease
Decreased PA
low volume
(check if CVP is low, BP low, UO low, and SVR low?)
Decreased PAWP
Fluid volume deficit
Increased PAWP
FLuid overload
Left ventricular failure
Besides CVP, what other measurements tell us about fluid status?
CVP and Wedge pressure can tell us.
Low PAWP = fluid volume deficit
High PAWP = fluid overload , left ventricular failure
What does PAWP measurement for a PA/Swanz indicate?
Reflects the preload of the left side of the heart (not the right like cvp)
What drug can cause a decrease in SVR?
What conditions can cause the SVR to decrease?
Nipride drops SVR due to it causing vasodilation
Shock states which are pretty much vasodilation states cause the SVR to drop as well
What can cause an increased SVR?
Vasoconstriction itself which can be caused by hypovolemia or vasoactive agents
- norepinephrine, phenylephrine, epinephrine, and vasopressin, dopamine
How does the PA/SWanz measure the cardiac output?
What is the normal range?
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
What is a low SV indicated of?
What is the norm?
Low SV means poor ventricular performance
Norm is 60-100 mL/min
What is SVV?
What if it greater than 15%?
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)
Complications to watch for with the PA/Swanz line
Infection and sepsis
Air embolus(due to disconnection)
Ventricular dysthymia
PA catheter may not be wedged
How do we deal with infection and sepsis with PA catheter?
Change flush bag, pressure tubing, transducer, and stopcock every 96 hours
When do the ventricular dysrhythmias occur with a PA/Swanz?
What is an intervention you can do to fix it?
When the tip migrates back from PA to Right ventricle. Try to reposition them on the left side. Then call the physician.
What do you do if a PA catheter isn’t able to be wedged ?
May need repositioning. Put on left side.
When using a PA/Swanz you know a pulmonary infarction or pulmonary rupture can occur. Why is this?
Overinflation if you use the wrong syringe
Prolonged inflation if you leave it inflated for too long
Spontaneous wedging
A thrombus can form.
What plugs go on the stopcock ports?
Deadenders or luer locks. Make sure to change them. (96 hours?)
red= arteries
blue = veins
Before inserting PA/swanz you need to grab baseline data. What does this include?
General appearance
LOC
Skin color and temp
Vital signs
Peripheral pulses
Urine output
Do this so we can compare the assessment
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