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NSCC 7520 > PA Lines > Flashcards

PA Lines Flashcards

1
Q

What are indications for the placement of PA line?

A

cardiogenic shock, pulmonary HTN, pre/post cardiac surgery management

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2
Q

What are normal values for CVP/RA pressures? What does this information tell us?

A

2-6/0-8 mmHg. Tell us about R heart preload.

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3
Q

When would we see RV pressures? What are normal ranges?

A

Seen during insertion only. RV systolic 20-30, RV diastolic 0-6.

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4
Q

What are normal PAS pressures? What does this number tell us?

A

20-30 mmHg. Tell us about pulmonary systolic pressures.

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5
Q

What are normal PAD pressures? What does this number tell us?

A

8-15 mmHg. Preload of L heart.

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6
Q

What are normal PA mean pressures?

A

10-20 mmHg

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7
Q

What are normal PCWP? What does this number tell us?

A

8-12 mmHg. Preload L heart.

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8
Q

What are normal SVR numbers? What does this tell us?

A

900-1400 dynes. Afterload of L heart. SYSTEMIC vascular resistance.

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9
Q

What are normal PVR numbers? What does this tell us?

A

50-150 dynes. Afterload of R heart. PULMONARY vascular resistance.

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10
Q

What are normal CO ranges?

A

4-8 lpm

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11
Q

What are normal CI ranges?

A

2.5 - 4 lpm

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12
Q

PCWP should always be below PADP by how much?

A

1-4 mmHg

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13
Q

Why is PADP used to estimate LV preload instead of PCWP routinely?

A

PCWP measurements increase risk of trauma and rupture to pulmonary artery. As long as PADP and PCWP correlate well (within 1-4 mmHg of eachother) then PADP can be used to determine LV preload

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14
Q

If the PADP is >4 mmHg than PCWP, what does this signify?

A

Patient is expereincing significant lung pathology

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15
Q

Can PCWP be higher than PADP?

A

no it is physically impossible

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16
Q

When obtaining a PCWP what are some safety things to consider?

A
  • only inject amount of air required to obtain a PCWP waveform (even if it is less than 1.5 cc)
  • observe PCWP waveform for 2-3 resp cycles and at end-respiration
  • disconnect syringe and allow balloon to deflate passively
17
Q

How is a patient positioned when obtaining PCWP?

A

HOB elevated <45 degrees, supine

18
Q

Why is it important to read PCWP values at end-expiration?

A

Minimizes influence of intrathoracic pressure fluctuations

19
Q

What are important steps to remember when obtaining cardiac outputs from a PA line?

A
  • injectate must be 10 degrees colder than blood
  • inject smooth and fast (no longer than 4 seconds)
  • must obtain 3 COs and discard values that are >10% different from eachother. all three values must be within 10 % of eachother
20
Q

What will a high CO produce when injectate is injected?

A

Quick rise to peak and a quicker return to baseline (less area under curve) as fluid passes the thermistor more quickly

21
Q

What will a low Co produce when injectate is injected?

A

Cure will have lower peak and will occur over a longer period of time as it takes more time for the cold fluid to pass the thermistor. Larger SA will be seen under curve.

22
Q

What is CI?

A

CO calculated with BSA

23
Q

When is it important to obtain a hemodynamic profile?

A
  • baseline
  • any acute changes
  • to assess specific interventions (fluid, vent setting changes, med titrations)
  • determine optimal PEEP
  • determine optimal FB
  • unit policy
24
Q

What needs to happen if the PAC is spontaneously wedging?

A

PAC needs to be pulled back. Nursing can pull back under direction from doc, but not allowed to advance.

25
Q

What are risks associated with spont wedging?

A

occluding BF and ischemia

26
Q

What could be causes of dampened PA waveform?

A
  • air in system, clot, catheter kinked, pressure bag <300, crack in transducer, incorrect stop-cock placement, blood in tubing
27
Q

What could be causes of PCWP pressure tracing unobtainable?

A

balloon ruptured, cath no longer in place

28
Q

what could be the cause of spont wedging in waveform? what should you do?

A

catheter is in too far. deep breathe/cough, position change (roll side to side), call doc as cath needs repositioning.

29
Q

what could be the cause of RV waveform appearing?

A

cath slipped back into RV

30
Q

What PAC value will tell us about CO/EOP?

A

Mixed venous O2 sat (SVO2)

31
Q

What PAC values will tell us about preload?

A

RA/CVP, PCWP

32
Q

What PAC values will tell us about afterload?

A

MAP, SVR, PVR

33
Q

What PAC values will tell us about contractility?

A

CO, CI

NSCC 7520 (4 decks)

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