Hemodynamics Flashcards
leveling a-line transducer
phelbostatic axis 4th ICS midaxillary
dicrotic notch
notch in a-line that represents aortic valve closure
a-line waveform feature that represents aortic valve closure
dicrotic notch
how to determine proper pressure in a-line system
determine dampening
*no more/less than 3 ossillations before returning to baseline
too little dampening
many ossillations. too little dampening that the ossillations won’t die and continue to reverberate
too much pressure in the a-line system
overdampening
obstruction in a-line system
overdampened
kinded a-line
overdampened
air in a-line
overdampened
pressure bag overfilled
overdampened
Boyle’s law on a-line
overdampened
what is overdampening
= obstruction in a-line system
too much pressure
causes of overdampened a-line
obstruction in aline system
kinked aline
air in system
pressure bag overfilled
Boyle’s law
underdampening
a-line system is too dynamic & has too little pressure
a-line if pressure bag isn’t full
underdampened -too little pressure
a-line if noncompliant tubing
underdampened - too little pressure
what does Swan Ganz measure
aka PUlmonary Artery Catheter
*right heart preload/afterload
*left heart preload
insertion site of a Swan Ganz/Pulmonary Artery catheter
central line into subclavin vein
what part of the PA catheter is used to measure pressure
distal tip
distal tip of the PA catheter
measure pressure
how much ml air to measure pressure via PA catheter
do not exceed 1.5ml
how to take wedge pressures
PA catheter
no more than 1.5ml into distal port
dtake at the end of exhalation
don’t take for longer than 15 sec or 3 breaths
how long to take a wedge pressure
no longer than 15 sec or 3 breaths
when do you take a wedge pressure
at the end of exhalation
PA catheter PA port
for monitoring/lab samples only
PA catheter port for monitoring/lab samples of blood
PA port
PA catheter port for infusions/fluids
proximal ports
proximal port on PA catheter
influsions/fluids
how to transport a pt with a PA catheter
deflate the balloon to prevent an inadgertent wedge pressure when it advances
*balloon size increases at altitude b/c Boyle’s Law
progression of Swan-Ganz
subclavian
R atrium/ventricle
destination = pulmonary artery
inflate in pulmonary artery to get wedge pressure
site where you get the wedge pressure =
pulmonary arteryq
dicrotic notch on the left side of PA catheter waveform
RV waveform = tricuspid valve closing
dicrotic notch on the right side of the waveform
PA waveform = pulmonic valve closing
measures right heart preload
Central venous pressure
2-6 mm hg
Central venous pressure
CVP = 2-6mm hg
right heart preload
2-6mm hg
Central Venous PRessure
right heart preload
Right ventriclar pressure
systolic = 15 - 25mm hg
diastolic = 0-5 mm hg
Pulmonary arty pressure
systolic = 15 - 25 mm hg
diastolic = 8-15
systolic pressure of right ventricle
15 - 25
diastolic pressure of right ventricle
0 - 5
systolic pressure of pulmonary artery
15 - 25 mm hg
diastolic pressure of pulmonary artery
8-15 mm hg
8-15 mm hg
diastolic pressure of pulmonary artery
15 - 25 mm hg
systolic pressure of right ventricle & pulmonary artery
PAWP
8-12 mm hg
8-12 mm hg
PAWP
what does PAWP measure
right heart afterload
left heart preload
how to measure left heart preload
PAWP
how to measure right heart afterload
PAWP
what is normal coronary perfusion pressure
50 - 60 mm hg
calculate coronary perfusion prssure
DBP - PAWP
= 50 - 60
normal CO
4-8L/min
normal cardiac index
2.5 - 5 L/min
catheter whip
exaggerated waveforms w/elevated systolic pressure and additional peaks (generally only 2 are found) = result of excessive movemnet of the catheter within the artery
how to deal w/catheter whip
inflate cuff w/1.5 ml air
cough
lay on right side
troubleshooting PA/Swan Ganz catheter
catheter whip
inadvertent wedge
2 cause of inadvertent wewdge
balloon migration
ensure the balloon is deflated (Boyle’s law)
treatment for inadvertent wedge
you’ll see a PAWP waveform
* deflate the balloon
* cough
* position pt
*withdraw until you see a PA waveform
causes of ireased PA pressure
left ventricular failure
liver failure/portal HTN
cor pulmonary/increased pulmomnary vascular resistance
mitral regurg/stenosis
why is MAP decreased in hypovolemia
loss of volume
central venous pressure in hypovolemia
decreased
SVR in hypovolemia
increased
CO in cardiogenic shock
decreased
central venous pressure in cardiovenic shock
decreased
PCWP
pulmonary capillary wedge pressure
indirect estimate of left atrial pressure
PCWP = pulmonary capillary wedge pressure