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6902- Cullen > PAC > Flashcards

PAC Flashcards

1
Q

2 indications for PAC monitoring in ICU?

A

diagnosis of respiratory failure or shock

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2
Q

indications for PAC monitoring in OR?

A

poor EF, valve disorders, separation from CPB

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3
Q

How do you calculate O2 delivery?

A

CaO2 x CO

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4
Q

End diastolic volume is?

A

preload

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5
Q

Calculated measurements from PAC?

A

PVR, SVR, SV, O2 delivery

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6
Q

Normal value PAP?

A

25/10

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7
Q

Normal value PAOP?

A

8-12

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8
Q

Normal value SvO2?

A

60-75%

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9
Q

Normal CI?

A

2.5-4 L/min

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10
Q

Normal SVR?

A

900-1200 dynes/sec/cm5

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11
Q

Normal PVR?

A

50-140

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12
Q

Normal SV?

A

50-100 mL

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13
Q

Normal SV index?

A

25-45

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14
Q

How do you calculate SVR?

A

[80x (MAP-RAP)/CO]

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15
Q

How do you calculate PVR?

A

[80 x (meanPAP-LAP)/pulmonary blood flow}

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16
Q

Some relative contraindications to inserting PAC?

A

large PE, coagulopathy, ventricular ectopy, LBBB, PM, ICD, severe pulmonary artery HTN

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17
Q

BBB complication of PAC?

A

RBBB

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18
Q

Easier side to float from for an IJ, for a SC?

A

RIJ; LSC

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19
Q

W femoral PAC placement, you risk what 2 things mainly?

A

infection and DVT

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20
Q

What is the length to RA, RV, PA, and PAOP if inserting a RIJ?

A

RA- 15-20; RV-30; PA- 40; PAOP-45-50

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21
Q

When inserting a PAC from the femoral vein, how far is the RA?

A

40-45

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22
Q

Do you flush and 0 the PAC prior to insertion?

A

yes

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23
Q

When should you have the catheter sheath in your hand?

A

before you give up the cordis tray

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24
Q

Once the catheter tip is in the RA, you should do what?

A

advance the tip w the balloon inflated

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25
Q

How do you withdraw the PAC?

A

with balloon deflated

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26
Q

With what speed do you advance the PAC in the RV?

A

quickly

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27
Q

When do you start advancing the catheter tip slowly?

A

once distal tip is in the PA

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28
Q

Do you want the PAC tip to be in the distal or middle PA?

A

middle

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29
Q

How is LA pressure measured w a PAC?

A

When wedging the PAC, blood flow is stopped at that site in the PA and therefore pressure from the LA is transmitted back up to that catheter tip

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30
Q

The tip of the PA catheter should be seen where on a chest xray?

A

no more than 3-5 cm from midline

31
Q

Pressures in West Zone I, II, and III look like?

A

I: A>a>v; II: a>A>v; III: a>v>A

32
Q

PAC should be in which zone?

A

III

33
Q

RA waveform looks like?

A

CVP w c, a, v upstrokes

34
Q

RV waveform looks like?

A

brisk upstroke and downstroke

35
Q

PA waveform?

A

brisk upstroke and downstroke flatten out and see notching

36
Q

PAOP waveform?

A

flattened waveform

37
Q

During PAC insertion, CVP pressure is measured with which part of the catheter?

A

when tip floats in to RA

38
Q

After PAC placement, CVP is measured with what?

A

proximal lumen of catheter

39
Q

When do a, c, and v waves occur?

A

a: atrial contraction; c: closure of tricuspid valve; v: blood filling atrium when tricuspid valve is closed

40
Q

When does x descent occur during a CVP waveform?

A

fall in right atrial pressure following atrial contraction

41
Q

When does y descent occur during CVP waveform?

A

fall in right atrial pressure following opening of tricuspid valve and passive ventricular filling

42
Q

When do the EKG waveforms occur in relation to the a, c, and v waves of CVP?

A

a right after p wave, c right after QRS, v right at ST segment

43
Q

mean RA pressure is roughly equivalent to what other pressure?

A

RVEDP

44
Q

Some causes of elevation of RAP?

A

hypervolemia, PE, RV infarction, impaired RV contraction, pul HTN, pulmonic stenosis, tricuspid valve disease, left to right shunts, cardiac tamponade

45
Q

Most stunning change in waveform as you go from the RV to the PA?

A

diastole increases

46
Q

PA systolic pressure is roughly equivalent to?

A

RV systolic

47
Q

PAOP waveform has which 2 waves?

A

a and v

48
Q

The mean PAOP is close to which value?

A

PAD

49
Q

If you think you are overwedging what action should you take?

A

put balloon down and withdraw catheter 1-2 cm

50
Q

Why does overwedging occur?

A

the PA is completely occluded so there is no sense of LA pressure

51
Q

PAEDP is equivalent to what 2 values?

A

PAOP and LVEDP

52
Q

The PAOP a wave is always where in relation to the EKG? And what does the a wave reflect?

A

at the end of the QRS; reflects LA contracting, LV filling, and MV open

53
Q

The PAOP v wave occurs where in relation to the EKG? And reflects what?

A

after T; reflects LA filling, MV closure, and LV contraction

54
Q

Using the PAOP waveform, how could you estimate PAOP?

A

locate the a wave just prior to the pressure decline and take the average a wave value

55
Q

What do inspiration and expiration do to the PAP during spontaneous ventilation and mechanical vent?

A
  • pressure during inspiration during spontaneous breathing causes decrease in PAP, exhalation during spontaneous breathing is typically active and causes increase in PAP; on a ventilator O2 is delivered under + pressure so during inspiration the PAP increases, whereas the PAP decreases on expiration bc it is typically passive
56
Q

PAP values are approximately the same at which point in the respiratory cycle and for that reason, that is when you should measure PAP?

A

end expiration

57
Q

How should you measure a CVP reading for a spontaneously breathing pt?

A

find the a wave just prior to the decline and average the a wave as the mean CVP value

58
Q

How do you measure a PAOP waveform in spontaneously breathing pt?

A

find beginning of pressure decline and locate a wave and take the mean value

59
Q

How do you measure a CVP or PAOP waveform w large a waves?

A

locate the a wave and average it

60
Q

When would you see large a waves/w what conditions?

A

noncompliant ventricle, mitral or tricuspid stenosis

61
Q

How do you measure the CVP/PAOP when there are large a waves and a dysrhythmia?

A

find a normal a wave and measure the value after the QRS or if there are no normal a waves, measure the pressure value at the end of the QRS complex

62
Q

Under what conditions would you not see a waves? And how would you measure the CVP/PAOP?

A

if the pt has a PM; measure the pressure value at the end of the QRS complex

63
Q

What are some cases that would cause large V waves?

A

tricuspid regurg, ventricular ischemia, ventricular failure, hypervolemia

64
Q

Early rapid filling comprises what % of RV filling?

A

60%

65
Q

Slow phase filing comprises what % of RV filling?

A

25%

66
Q

How would you detect a left to right shunt?

A

detection of an O2 saturation step up (>10% rise in O2 sat)

67
Q

When your RAP = RVED= PCWP, that is an ominous sign and what are the 3 possibilities of what is happening?

A

tamponade, constrictive pericardial disease, and restrictive cardiomyopathy

68
Q

To measure CO, saline is injected through which port on a PAC?

A

proximal

69
Q

What characteristics do you want to see on a CO curve?

A

smooth even upstroke and downstroke

70
Q

The area under a CO curve is inversely proportional to what?

A

rate of blood flow past the PA

71
Q

CO curves should not differ by more than what % to obtain a mean CO?

A

10

72
Q

Some physical problems that decrease the accuracy of thermodilution CO?

A

tricuspid regurg, septal defects

73
Q

How does continuous thermodilution CO work?

A

theres a thermal filament located 15-25 cm from the catheter tip and it generates low energy head pulses transmitted to surrounding blood

6902- Cullen (10 decks)

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