Pulmonary Artery Catheter

Question 0

What size is the standard PAC?

Answer 0

7, 7.5, or 8 Fr

110 cm in length

Question 1

What is a pulmonary artery catheter used for?

Answer 1

Hemodynamics assessment of patients with acute myocardial infarction

Question 2

The syringe that comes with the PAC is only

Answer 2

1.5 ml

Question 3

How many lumens does the PAC have?

Answer 3

4-5

Question 4

Pulmonary artery blood temperature is measured through the

Answer 4

Temperature thermistor

Question 5

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

Answer 5

Proximal port

Question 6

The distal port is for

Answer 6

PAP monitoring

Question 7

The variable infusion port is used for

Answer 7

Fluid and drug afministration

Question 8

The balloon is located at

Answer 8

The catheter tip

Question 9

PAC insertion is facilitated using a

Answer 9

Large bore introducer catheter

Question 10

The PAC is inserted through _______ with the patient in

Answer 10

The subclavian or IJ

Trendelenburg

Question 11

Prior to PAC insertion, the transducer is

Answer 11

Connected to the distal port

Leveled and zeroed

Question 12

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

Answer 12

Continuous

Question 13

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

Answer 13

20 cm

Question 14

Usually around 45-55 cm, the ________ is obtained

Answer 14

Pulmonary capillary wedge pressure (PCWP)

Question 15

Normal values and wave configurations produced by PAC

Answer 15

View chart

Question 16

Indications for PAC

Answer 16

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

Question 17

Hemodynamics parameters

Answer 17

Chart

Question 18

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

Answer 18

CVP

Question 19

CVP equals right ventricular end diastolic pressure (RVEDP) when

Answer 19

No obstruction exists between atrium and ventricle

CVP also equals right atrium pressure (RAP)

Question 20

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

Answer 20

Deflated

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

Question 21

Recorded from the tip of catheter with balloon inflated

Answer 21

Pulmonary capillary wedge pressure (PCWP)

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

Question 22

Cardiac output is calculated using

Answer 22

Thermodilution technique

Question 23

What is the thermodilution technique?

Answer 23

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

Question 24

Formula for cardiac index

Answer 24

CI = CO/BSA

Question 25

Formula for stroke volume index

Answer 25

SVI = CI/HR

Question 26

Systemic vascular resistance

Answer 26

Reflects impedance of the systemic vascular tree | SVR = 80 x (MAP-CVP)/CO

Question 27

Pulmonary vascular resistance

Answer 27

Reflects impedance of pulmonary circuit | PVR = 80 x (PAM - PCWP)/CO

Question 28

Left ventricular stroke work index (LVSWI)

Answer 28

LVSWI = (MAP - PCWP) x SVI x 0.136

Question 29

Right ventricular stroke work index (RVSWI)

Answer 29

RVSWI = (PAM - CVP) x SVI x 0.136

Question 30

Oxygen delivery

Answer 30

DO2 = CI x 1.34 x Hgb x SaO2

Question 31

Mixed venous oxygen saturation is the oxygen saturation in

Answer 31

Pulmonary artery blood | Used to detect impaired tissue oxygenation

Question 32

Oxygen uptake

Answer 32

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

Question 33

What are the benefits to PAC?

Answer 33

Effect on treatment decisions Preoperative catheterization Perioperative monitoring

Question 34

PAC complications of establishment of central venous access

Answer 34

``` Bleeding Neuropathy Air embolism Pneumothorax Accidental puncture of adjacent arteries ```

Question 35

PAC complications of pulm artery catheterization

Answer 35

Dysrrhythmias Right bundle branch block Minor increase in tricuspid regurgitation

Question 36

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

Answer 36

Preexisting LBBB

Question 37

PAC complications of pulm catheter residence

Answer 37

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

Question 38

How frequently does pulmonary artery rupture occur? Mortality rate?

Answer 38

0.03-0.2% | 41-70% mortality

Question 39

ASA guidelines for PAC states appropriateness depends on

Answer 39

Patient Surgery Practice setting Basically anything that can influence hemodynamics instability should be taken into account

Question 40

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

Answer 40

Have a high risk of complications from hemodynamics changes | Have advanced cardiopulmonary disease

Question 41

Patient population of Sandhams random study

Answer 41

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

Question 42

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

Answer 42

False. No benefit

Question 43

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

Answer 43

Pulmonary embolism