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I&M for Anesthesia - Fall 2013 > Pulmonary Artery Catheter > Flashcards

Pulmonary Artery Catheter Flashcards

0
Q

What size is the standard PAC?

A

7, 7.5, or 8 Fr

110 cm in length

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1
Q

What is a pulmonary artery catheter used for?

A

Hemodynamics assessment of patients with acute myocardial infarction

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2
Q

The syringe that comes with the PAC is only

A

1.5 ml

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3
Q

How many lumens does the PAC have?

A

4-5

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4
Q

Pulmonary artery blood temperature is measured through the

A

Temperature thermistor

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5
Q

CVP monitoring, fluid, and drug administration is done through the

A

Proximal port

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6
Q

The distal port is for

A

PAP monitoring

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7
Q

The variable infusion port is used for

A

Fluid and drug afministration

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8
Q

The balloon is located at

A

The catheter tip

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9
Q

PAC insertion is facilitated using a

A

Large bore introducer catheter

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10
Q

The PAC is inserted through _______ with the patient in

A

The subclavian or IJ

Trendelenburg

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11
Q

Prior to PAC insertion, the transducer is

A

Connected to the distal port

Leveled and zeroed

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12
Q

What kind of pressure monitoring during PAC section is required to determine the location of the catheter tip?

A

Continuous

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13
Q

The balloon is inflated when the hub of the introducer is at

A

20 cm

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14
Q

Usually around 45-55 cm, the ________ is obtained

A

Pulmonary capillary wedge pressure (PCWP)

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15
Q

Normal values and wave configurations produced by PAC

A

View chart

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16
Q

Indications for PAC

A 
Assess volume status
RV or LV failure
Pulmonary hypertension
Valvular disease
Cardiac surgery
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17
Q

Hemodynamics parameters

A

Chart

18
Q

Recorded from the proximal port of the PAC int he superior vena cava or right atrium

A

CVP

19
Q

CVP equals right ventricular end diastolic pressure (RVEDP) when

A

No obstruction exists between atrium and ventricle

CVP also equals right atrium pressure (RAP)

20
Q

Pulmonary artery pressure (PAP) is measured at the tip with ballon

A

Deflated

Reflects right ventricle function, pulmonary vascular resistance, and left atrium filling pressures

21
Q

Recorded from the tip of catheter with balloon inflated

A

Pulmonary capillary wedge pressure (PCWP)

PCWP = LAP - LVEDP (when no obstruction exists between atrium and ventricle)

22
Q

Cardiac output is calculated using

A

Thermodilution technique

23
Q

What is the thermodilution technique?

A

Using the thermistor to record the change in temperature of blood flowing through pulmonary artery when cold fluid is injected into the right atrium
Measure of cardiac output

24
Q

Formula for cardiac index

A

CI = CO/BSA

25
Q

Formula for stroke volume index

A

SVI = CI/HR

26
Q

Systemic vascular resistance

A

Reflects impedance of the systemic vascular tree

SVR = 80 x (MAP-CVP)/CO

27
Q

Pulmonary vascular resistance

A

Reflects impedance of pulmonary circuit

PVR = 80 x (PAM - PCWP)/CO

28
Q

Left ventricular stroke work index (LVSWI)

A

LVSWI = (MAP - PCWP) x SVI x 0.136

29
Q

Right ventricular stroke work index (RVSWI)

A

RVSWI = (PAM - CVP) x SVI x 0.136

30
Q

Oxygen delivery

A

DO2 = CI x 1.34 x Hgb x SaO2

31
Q

Mixed venous oxygen saturation is the oxygen saturation in

A

Pulmonary artery blood

Used to detect impaired tissue oxygenation

32
Q

Oxygen uptake

A

VO2 = CI x 1.34 x Hgb x (SaO2-SvO2)

33
Q

What are the benefits to PAC?

A

Effect on treatment decisions
Preoperative catheterization
Perioperative monitoring

34
Q

PAC complications of establishment of central venous access

A 
Bleeding
Neuropathy
Air embolism
Pneumothorax
Accidental puncture of adjacent arteries
35
Q

PAC complications of pulm artery catheterization

A

Dysrrhythmias
Right bundle branch block
Minor increase in tricuspid regurgitation

36
Q

A RBBB can lead to a complete heart block if the patient already has

A

Preexisting LBBB

37
Q

PAC complications of pulm catheter residence

A 
Thromboembolism
Mechanical, catheter knots
Pulmonary infarction
Infection, endocarditis
Endocardial damage, cardiac valve injury
Pulmonary artery rupture
38
Q

How frequently does pulmonary artery rupture occur? Mortality rate?

A

0.03-0.2%

41-70% mortality

39
Q

ASA guidelines for PAC states appropriateness depends on

A

Patient
Surgery
Practice setting

Basically anything that can influence hemodynamics instability should be taken into account

40
Q

According to Task Force in Pulm Artery Catheterization, PAC is necessary in surgical patients who

A

Have a high risk of complications from hemodynamics changes

Have advanced cardiopulmonary disease

41
Q

Patient population of Sandhams random study

A

High risk
> 60
ASA III/IV
Urgent or elective major surgery

42
Q

T or F. The random study showed that PAC are more beneficial than standard care.

A

False. No benefit

43
Q

In the randomized study, the PAC group showed an increase of

A

Pulmonary embolism

I&M for Anesthesia - Fall 2013 (13 decks)

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