PA - Pulmonary Artery Cath (swan-ganz) Flashcards
PA (invasive) cath used for?
acute management of patients with Acute cardiac, pulmonary and intravascular problems
PA ports.
1.
PA (pulmonary artery) is the same as art line with?
Pressure bag
Nurses help assist with for PA?
- Sterile tech
- Check labs
- Gather supplies
- Informed consent - we get it signed and answer questions
- IJ, Subclavian, femoral vein
- Watch waveforms, EKG
- When in RA (right atrium) ballon is inflated - floats through tricuspid, RV, pulmonic valve, into PA and will wedge it. Then deflated.
- Chest Xray to confirm placement before infusing anything inot
Nursing intervention with PA cath
- Assist with insertion
- Monitor waveform
- Observe to PVC or Afib
- Observe for accidental wedging of cath
- Maintain sterile dressing
- Chest XRay needs to been done before anything goes in the ports
Complications of a PA cath?
Pneumothorax
Ventricular dysrhythmias
Pulmonary artery rupture or perforation
Infection
SVR - systemic vascular resistance
Pressure by LV afterload - resistance of the blood flow in the vascular system
PA pressure and PAWP indicate?
Cardiac function and fluid volume status
PA pressure monitoring table 14.16
- Allows for correction of fluid status without overloading
- Allows precise measurement of preload without risk of pulmonary edema
- Intra-thoracic pressure alters PA pressure so measure at end of expiration- the continuous waveform is the measurement
PA pressure normal values?
15-25/ 8-12mm Hg
Mean is 8-15
PAWP normal range
8-12 mmHg
How to measure PAWP?
Slowly inflate 1-1.5 ml until you see PAWP waveform and do not inflate for more than 4 respiratory cycles
CVP - RA pressure
Measures RV preload
Reflects fluid status
Increased CVP volume overload or RV failure
Decreased CVP is hypovolemia
CVP normal range
2-8 mmHg
Normal CO
4-8 L/min
Normal CI
2.5-4.2 L/min
What would decreased CO/CI?
Cardiogenic shock, hypovolemic shock, HF
What would increase CO/CI?
Hyper-dynamic state like fever or sepsis
Methods on evaluating CO
- Thermodilution (gold standard)
- Arterial pressure and waveform based methods
- Electrical bio cardiography
- Esophageal Doppler monitoring
Thermodilution tech
Intermittent or Continuous ( specialize PACs with thermal filaments)
Thermodilution measuring CO
- Intermittently bolus 5-10 ml of room temp or cool saline using the proximal lumen PA cath and push rapidly
- The thermistor senses temp change in blood
- Repeat 3 times, q 1-2 mins
- Discard any reading that doesn’t show a normal curve
- Computer calculates the CO from the average
Measuring CO thermodilution
SV and SVR can be calculated with CO measures
Increased SVR
Vasoconstriction (shock, HTN, vasoactive drugs)
Decreased SVR
Vasodilation (septic or neurogenic shock, afterload, decreasing drugs)
