Module 2: Hemodynamic Monitoring Flashcards
1). Normal value for monitoring PA pressures are
A. 2-6/8-14 mmHg
B. 15-25/8-15 mmHg
C. 25-35/20-30 mmHg
D. 2.5-4.2 L/minute
B: PAS 15-25 mmHg and PAD 8-15 mmHg.
2). Describe what happens with Right Ventricular pressure on hemodynamic waveform.
The anacrotic notch is seen on the left side of the waveform “looks like VT,” catheter is positioned in the right ventricle. The rise in pressure begins simultaneously with ventricular depolarization (the QRS). When the right ventricle pressure is measured from a pulmonary artery catheter, the distance between the catheter tip and the transducer produces a delay between the QRS and the appearance of the rise in ventricular pressure. With a sinus rhythm, a small pressure rise in the right ventricular pressure occurs as the atrial contracts and increases the ventricular volume. Note that the wave will look taller in appearance than a PA waveform.
3). Trouble shooting a hemodynamic monitoring catheter.
You must be able to recognize when the PA catheter is in the right ventricle. Initial intervention would be to attempt to float the PA catheter out of the right ventricle and into the pulmonary artery. If not successful, the PA catheter should be pulled back into the right atrium. Remember to change your lines from the proximal port to the distal port if PA catheter is repositioned in the right atrium. If the presence of the PA catheter in the right ventricle is not recognized and managed, the patient may develop PVCs and/or VT.
What to do if catheter has been pulled back and is in the right ventricle?
- Reassess catheter centimeters at entry site
- Have the patient lay on their side
- Inflate the balloon (PAWP waveform will not be seen)
- Pull catheter back to RA position
- Change IV lines to distal port lumen if catheter has been pulled back into the right atrium
4) Describe what happens in a PA waveform tracing.
PA waveform, note the dicrotic notch is seen on the right side of the waveform. The pulmonary artery waveform can be correlated with the electrical activity of the right ventricle and the corresponding pressure changes occurring in the pulmonary artery. The systolic phase (PAS) reflects right ventricular contraction; therefore, the systolic pressure rise occurs after the QRS complex on the ECG.
5). Describe waveform tracing for PA into “Wedged” Position (PAWP).
PA into “wedged” position (PAWP). The PAWP should always be lower than the mean pulmonary artery pressures (PAP). If it appears higher than mean PAP, suspect an error or that the catheter tip is not in the proper position. If it is not in the correct position, the PAWP may reflect alveolar or airway pressure and would not accurately reflect left atrial pressure. In addition to the mean PAP being higher than PAWP, pulmonary artery diastolic (PAD) pressure should be higher than PAWP. This is because the higher pressure in the pulmonary artery is needed to push the blood into the left atrium.
6). The patient’s PA catheter is exhibiting a large, well defined hemodynamic waveform with an obvious “notch” on the left side of the waveform. The distal tip is most likely located in the
A. right atrium
B. pulmonary artery
C. pulmonary capillary
D. right ventricle
D: right ventricle (clue: obvious notch on the left side of the waveform) Clues that will assist in determining an RV waveform are:
- The wave will look taller in appearance than a PA waveform
- An RV waveform is symmetrical in shape; there is no dicrotic notch seen on the right side (downslope) of the waveform
- The right ventricular pressure rise is closer to the QRS than with PAP waveform
- Inflation of the catheter balloon fails to produce a PAWP waveform.
7). Describe what happened when you have small waveform tracing to bigger waveform tracing.
PAWP into PA waveform. PAWP is lower than PAD.
8). Your patient presents with the following hemodynamic parameters: CVP 28, CI 1.2, PA S/D 48/29, wedge 27, and SVR 2100. Identify the waveform tracing. wide with “w” on the Tracing.
Atrial pressure waves are created by the pressure changes occurring in the right atrium during right atrial systole and diastole. The “a” wave is generated during atrial systole, and its height is a direct result of how much pressure is occurring in the atrium as the blood is being ejected into the ventricle.
9). A common cause of elevated PA pressures is
A. mitral valve stenosis
B. mitral valve regurgitation
C. left ventricular failure
D. all of the above
D: All of the above (Review the following chart for causes of increased and decreased hemodynamic pressures).
10). Identify the following hemodynamic waveform tracing.
A. CVP
B. RV
C. PAWP
D. PA
C: PAWP waveform (note the “rolling” amplitude) What Increased PAWP Readings May Signify Early pulmonary congestion = 20 mmHg Moderate pulmonary congestion = 25 mmHg Severe pulmonary congestion = 30 mmHg
