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I & M > PA Pressure w/ Swan-Ganz > Flashcards

PA Pressure w/ Swan-Ganz Flashcards

1
Q

Label the following picture.

A

1) Big white connector = Thermistor connection
2) Orange wire = paceport connector
3) Yellow wire only = Tip of swan-ganz
4) Yellow wire with white connector = PA port
5) Blue wire = Proximal port
6) Red wire = Injection port for balloon

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2
Q

How long is a a normal Swan Ganz catheter?

A

110 cm

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3
Q

What can the paceport be used for (2)?

A
  1. Pacing the right ventricle
  2. As a venous infusion port
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4
Q

A. What often occurs as a result of the catheter residing in both the atrium and ventricle?

B. If this issue does not resolve on its own, what can you do to fix it?

A

A. Ectopy

B. Give boluses of Lidocaine or start an infusion (to reduce the excitability)

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5
Q

A. How many lumens does a typical Swan-Ganz cather have?

B. Name each of them.

A

A. 4 lumens

B. Thermistor, balloon, infusion, and distal lumens

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6
Q

What curve do you get from the thermistor?

A

Thermodilution curve

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7
Q

What pressure does the distal lumen give you?

A

PA/PCWP (pulmonary artery/pulmonary capillary wedge pressure)

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8
Q

What does the proximal lumen give you?

A

RAP (right atrial pressure)

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9
Q

What is the maximum volume you can inject into the bung stop (retard)?

A

1.5 cc

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10
Q

How many centimeters from the PA distal end is the thermistor opening?

A

3 cm

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11
Q

How many centimeters from the PA distal end is the RV port opening?

A

19 cm

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12
Q

How many centimeters from the PA distal end is the proximal injectate port opening?

A

30 cm

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13
Q

What main manufacturer makes the paceport catheter with the right ventricular port which allows for passage of a ventricular pacing wire?

A

Chandler (the Chandler Ventricular Pacing Probe)

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14
Q

A. What is the external diameter of the Swan-Ganz catheter?

B. What is the minimum introducer size?

A

A. 7.5 French

B. 8.0 French (want this to be 0.5-1.0 French sizes larger than the catheter)

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15
Q

Where do you place the introducer, and in what position should the patient be in when placing it?

A

Into the RIJV (like CVL) with patient in Trendelenburg

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16
Q

What is passed over the guidewire (consists of two components)?

A

A percutaneous introducer consisting of a vessel dilator and sheath

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17
Q

What does VIP stand for (part of the Swan-Ganz)?

A

Venous infusion port

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18
Q

What change do you see in the waveform as you pass the catheter from the RA to the RV?

A

Sharp increase in “systolic” pressure

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19
Q

As the catheter tip enters the pulmonary artery, a ____ may occur in the systolic wave, and the diastolic pressure will ____ in magnitude and will be ____-sloping.

A

dicrotic notch

increase

down-sloping

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20
Q

With further advancement of the cather, the balloon will occlude blood flow and the tip will record the _____ pressure, which is characterized by what?

A

Will record the pulmonary artery occlusion pressure, characterized by disappearance of the “systolic” pressure wave and reappearance of venous a, c, and v waves

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21
Q

When the ballon is inflated to occlude the pulmonary artery, the distal port of the catheter measures ___ which ordinarily reflects ___ pressure?

A

the venous backpressure downstream from the balloon

left atrial pressure

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22
Q

Right ventriclular pressure shows a ___ systolic pressure than seen in the right atrium, although the end-diastolic pressure are ___ in these two chambers.

A

higher

equal

23
Q

Right ventricular systolic pressure = ?

A

RVSP = PASP (pulmonary artery systolic pressure)

24
Q

The pulmonary artery occlusion pressure (PAOP) = WEDGE pressure, which is also equal to what other two pressures?

A

LAP and LVEDP

25
Q

RAP equals what?

A

RVEDP

26
Q

RVEDP < ?

A

PADP

27
Q

PADP is approximately equal to what two pressures?

A

LAP and LVEDP

28
Q

Pulmonary artery wedge pressure measurement creates a ____ of blood connecting the catheter tip to a junction point where flow resumes in the pulmonary veins near the left atrium.

A

static column of blood

29
Q

In order to provide an accurate measure of pumonary venous or left atrial pressure, the tip of the PA catheter must be wedged in which lung zone? Why?

A

Lung Zone 3

Because alveolar pressure must be the lowest pressure in the zone in order for the wedge pressure to reflect intravascular pressure instead of alveolar pressure.

Zone 1: P(A) > P(a) > P(V)

Zone 2: P(a) > P(A) > P(V)

*Zone 3: P(a) > P(V) > P(A)*

30
Q

Pulmonary artery wedge pressure a-c and v waves occur ____ in the cardiac cycle than their counterparts on the right side of the heart seen in a CVP trace.

A

Later

31
Q

The LAP and CVP waveforms have nearly identical morphologies, but the CVP a wave slightly ____ the LAP a wave (temporal relationship between the two waveforms).

A

precedes

32
Q

True/False

Pulmonary artery wedge pressure (PAWP) is a damped, delayed reflection of left atrial pressure (LAP).

A

True

33
Q

What causes the artifactual pressure peaks and troughs in the pulmonary artery pressure waveform?

A

Catheter tip motion

34
Q

A. What is overwedging of the pulmonary artery catheter?

B. What does overwedging of the pulmonary artery catheter cause?

C. Solution?

A

A. When the catheter tip impinges against the vessel wall, or balloon herniation over the catheter tip

B. Artifactual waveforms (saw-toothed waveform)

C. Immediately deflate the balloon and withdraw the catheter 1-2 cm. Slowly reinflate the balloon until waveform returns to normal

35
Q

Above what PA pressure should you cancel the case until the patient’s pulmonary hypertension is under control?

A

Above PA pressures of 60 (under 40 is normal systolic PAP)

36
Q

You should minimize the number of PCWP measurements in which patient populations (3)?

A
  1. Elderly
  2. Anticoagulated
  3. Pulmonary HTN
37
Q

If PA diastolic pressure is < ___ mm Hg, use PA diastolic pressure rather than PCWP as an index of left ventricular filling pressure.

A

18 mm Hg

38
Q

Upon transition from the PA to the pulmonary capillary wedge pressure trace, what should you do?

A

Immediately stop inflation!

39
Q

Distances from RIJV insertion site to

a) right atrium?
b) right ventricle?
c) pulmonary artery?
d) pulmonary artery wedge?

A

RIJV is

a) 20 cm from RA
b) 30-35 cm from RV
c) 40-45 cm from PA
d) 50 cm from PAW

*if asked for one number instead of range, choose the bolded, underlined value

40
Q

Advantages of percutaneous cannulation of the central internal jugular vein?

A
  1. Rapidly accessible
  2. Does not interfere w/ CPR
  3. Provides a straight route to the heart
  4. Less restrictive to patient movement
41
Q

Disadvantages of percutaneous cannulation of the central internal jugular vein?

A
  1. Air embolism, carotid artery puncture, &/or tracheal injury may occur
  2. Pneumothorax (more common in the left than the right internal jugular vein)
  3. Thoracic duct injury (left internal jugular vein only)
42
Q

Equation for Systemic Vascular Resistance

A

SVR = (MAP - RAP) / CO

43
Q

Equation for Pulmonary Vascular Resistance

A

PVR = (PAP - PCWP) / CO

44
Q

To convert HRU (Wood units, or hybrid resistance units) to ARU (absolute resistance units), multiply by ___?

A

HRU –> ARU, multiply by 79.9

45
Q

What is normal range for PA end-diastolic pressure?

A

4-12 mm Hg

46
Q

What is normal range for pulmonary artery wedge mean pressure?

A

4-12 mm Hg

47
Q

What is normal range for LA mean pressure?

A

2-12 mm Hg

48
Q

What is normal range for LV end-diastolic pressure?

A

5-12 mm Hg

49
Q

True/False

PA end-diastolic pressure is a good indicator of pulmonary artery wedge pressure–if no change in PAEDP, then there is no need to check PA wedge pressure.

A

True

50
Q

A. Normal range for CO (L/min)?

B. Normal range for SV (mL)?

A

A. CO = 4.0-6.5 L/min (or 5.0)

B. SV = 60-90 mL (or 75)

51
Q

What risk factors are associated with pulmonary artery perforation (6)?

A
  1. Advanced age
  2. Hypothermia
  3. Pulmonary HTN
  4. Female gender
  5. Radiation therapy to the area (e.g. for breast cancer)
  6. Deviations from standard insertion techniques
52
Q

Mechanisms of pulmonary artery perforation (3)?

A
  1. Tip perforation of the vasculature
  2. Eccentric balloon configuration propelling the balloon through the vessel wall
  3. Balloon inflation disrupting the pulmonary artery (mean intraballoon pressure = 250 mm Hg)
53
Q

Go to answer

A

BOO!!!!!!

I & M (37 decks)

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