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Perfusion > PA - Pulmonary Artery Cath (swan-ganz) > Flashcards

PA - Pulmonary Artery Cath (swan-ganz) Flashcards

1
Q

PA (invasive) cath used for?

A

acute management of patients with Acute cardiac, pulmonary and intravascular problems

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2
Q

PA ports.

A

1.

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3
Q

PA (pulmonary artery) is the same as art line with?

A

Pressure bag

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4
Q

Nurses help assist with for PA?

A
  1. Sterile tech
  2. Check labs
  3. Gather supplies
  4. Informed consent - we get it signed and answer questions
  5. IJ, Subclavian, femoral vein
  6. Watch waveforms, EKG
  7. When in RA (right atrium) ballon is inflated - floats through tricuspid, RV, pulmonic valve, into PA and will wedge it. Then deflated.
  8. Chest Xray to confirm placement before infusing anything inot
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5
Q

Nursing intervention with PA cath

A
  1. Assist with insertion
  2. Monitor waveform
  3. Observe to PVC or Afib
  4. Observe for accidental wedging of cath
  5. Maintain sterile dressing
  6. Chest XRay needs to been done before anything goes in the ports
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6
Q

Complications of a PA cath?

A

Pneumothorax
Ventricular dysrhythmias
Pulmonary artery rupture or perforation
Infection

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7
Q

SVR - systemic vascular resistance

A

Pressure by LV afterload - resistance of the blood flow in the vascular system

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8
Q

PA pressure and PAWP indicate?

A

Cardiac function and fluid volume status

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9
Q

PA pressure monitoring table 14.16

A
  1. Allows for correction of fluid status without overloading
  2. Allows precise measurement of preload without risk of pulmonary edema
  3. Intra-thoracic pressure alters PA pressure so measure at end of expiration- the continuous waveform is the measurement
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10
Q

PA pressure normal values?

A

15-25/ 8-12mm Hg

Mean is 8-15

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11
Q

PAWP normal range

A

8-12 mmHg

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12
Q

How to measure PAWP?

A

Slowly inflate 1-1.5 ml until you see PAWP waveform and do not inflate for more than 4 respiratory cycles

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13
Q

CVP - RA pressure

A

Measures RV preload
Reflects fluid status
Increased CVP volume overload or RV failure
Decreased CVP is hypovolemia

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14
Q

CVP normal range

A

2-8 mmHg

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15
Q

Normal CO

A

4-8 L/min

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16
Q

Normal CI

A

2.5-4.2 L/min

17
Q

What would decreased CO/CI?

A

Cardiogenic shock, hypovolemic shock, HF

18
Q

What would increase CO/CI?

A

Hyper-dynamic state like fever or sepsis

19
Q

Methods on evaluating CO

A
  1. Thermodilution (gold standard)
  2. Arterial pressure and waveform based methods
  3. Electrical bio cardiography
  4. Esophageal Doppler monitoring
20
Q

Thermodilution tech

A

Intermittent or Continuous ( specialize PACs with thermal filaments)

21
Q

Thermodilution measuring CO

A
  1. Intermittently bolus 5-10 ml of room temp or cool saline using the proximal lumen PA cath and push rapidly
  2. The thermistor senses temp change in blood
  3. Repeat 3 times, q 1-2 mins
  4. Discard any reading that doesn’t show a normal curve
  5. Computer calculates the CO from the average
22
Q

Measuring CO thermodilution

A

SV and SVR can be calculated with CO measures

23
Q

Increased SVR

A

Vasoconstriction (shock, HTN, vasoactive drugs)

24
Q

Decreased SVR

A

Vasodilation (septic or neurogenic shock, afterload, decreasing drugs)

25
Q

Impedance cardiography (noninvasive)

A

Electrodes that measure the flow of volume

26
Q

NG tube with doppler

A

Monitors blood flow velocity through descending aorta

27
Q

Oxygen supply and demand

A

Needs adequate vascular tone to supply and deliver oxygen to cells
Adequate circulation back to heart
Perfusion vs what body needs

28
Q

Oxygen based on?

A

CO/CI
Hemoglobin
Arterial oxygen saturation

29
Q

Sv02 normal range

A

60-80%

30
Q

Lactate normal range

A

0.5-2.2 so > than 2.2 means cellular death and how low is pH

31
Q

Base Excess/ Base Deficit

A

Amount of base needed to titrate on liter of blood to a pH of 7.40 can range - or + 2

32
Q

Cause of increase oxygen demand

A

Stress, pain, anxiety, fever

33
Q

Causes of insufficient oxygen delivery

A

Decreased CO, Hgb, SaO2

34
Q

Decreased Oxygen demand

A

Sedation, pain relief, hypothermia

35
Q

Increased oxygen delivery

A

Increased CO, HgB, Sa02

36
Q

Gastric Tonometry

A

NG tube with gas-permeable balloon and CO2 diffuses from the gastric wall into ballon and allows measurement of PCO2 and gastric pH

37
Q

Hypoperfusion of oxygen

A

Indicates oxygen delivery- H2 blockers may affect the gastric tonometry

38
Q

Sublingual capnometry

A

Measures PCO2 under the tongue

Perfusion (2 decks)

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