Pulmonary Artery Catheter Flashcards
What size is the standard PAC?
7, 7.5, or 8 Fr
110 cm in length
What is a pulmonary artery catheter used for?
Hemodynamics assessment of patients with acute myocardial infarction
The syringe that comes with the PAC is only
1.5 ml
How many lumens does the PAC have?
4-5
Pulmonary artery blood temperature is measured through the
Temperature thermistor
CVP monitoring, fluid, and drug administration is done through the
Proximal port
The distal port is for
PAP monitoring
The variable infusion port is used for
Fluid and drug afministration
The balloon is located at
The catheter tip
PAC insertion is facilitated using a
Large bore introducer catheter
The PAC is inserted through _______ with the patient in
The subclavian or IJ
Trendelenburg
Prior to PAC insertion, the transducer is
Connected to the distal port
Leveled and zeroed
What kind of pressure monitoring during PAC section is required to determine the location of the catheter tip?
Continuous
The balloon is inflated when the hub of the introducer is at
20 cm
Usually around 45-55 cm, the ________ is obtained
Pulmonary capillary wedge pressure (PCWP)
Normal values and wave configurations produced by PAC
View chart
Indications for PAC
Assess volume status RV or LV failure Pulmonary hypertension Valvular disease Cardiac surgery
Hemodynamics parameters
Chart
Recorded from the proximal port of the PAC int he superior vena cava or right atrium
CVP
CVP equals right ventricular end diastolic pressure (RVEDP) when
No obstruction exists between atrium and ventricle
CVP also equals right atrium pressure (RAP)
Pulmonary artery pressure (PAP) is measured at the tip with ballon
Deflated
Reflects right ventricle function, pulmonary vascular resistance, and left atrium filling pressures
Recorded from the tip of catheter with balloon inflated
Pulmonary capillary wedge pressure (PCWP)
PCWP = LAP - LVEDP (when no obstruction exists between atrium and ventricle)
Cardiac output is calculated using
Thermodilution technique
What is the thermodilution technique?
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
Formula for cardiac index
CI = CO/BSA
Formula for stroke volume index
SVI = CI/HR
Systemic vascular resistance
Reflects impedance of the systemic vascular tree
SVR = 80 x (MAP-CVP)/CO
Pulmonary vascular resistance
Reflects impedance of pulmonary circuit
PVR = 80 x (PAM - PCWP)/CO
Left ventricular stroke work index (LVSWI)
LVSWI = (MAP - PCWP) x SVI x 0.136
Right ventricular stroke work index (RVSWI)
RVSWI = (PAM - CVP) x SVI x 0.136
Oxygen delivery
DO2 = CI x 1.34 x Hgb x SaO2
Mixed venous oxygen saturation is the oxygen saturation in
Pulmonary artery blood
Used to detect impaired tissue oxygenation
Oxygen uptake
VO2 = CI x 1.34 x Hgb x (SaO2-SvO2)
What are the benefits to PAC?
Effect on treatment decisions
Preoperative catheterization
Perioperative monitoring
PAC complications of establishment of central venous access
Bleeding Neuropathy Air embolism Pneumothorax Accidental puncture of adjacent arteries
PAC complications of pulm artery catheterization
Dysrrhythmias
Right bundle branch block
Minor increase in tricuspid regurgitation
A RBBB can lead to a complete heart block if the patient already has
Preexisting LBBB
PAC complications of pulm catheter residence
Thromboembolism Mechanical, catheter knots Pulmonary infarction Infection, endocarditis Endocardial damage, cardiac valve injury Pulmonary artery rupture
How frequently does pulmonary artery rupture occur? Mortality rate?
0.03-0.2%
41-70% mortality
ASA guidelines for PAC states appropriateness depends on
Patient
Surgery
Practice setting
Basically anything that can influence hemodynamics instability should be taken into account
According to Task Force in Pulm Artery Catheterization, PAC is necessary in surgical patients who
Have a high risk of complications from hemodynamics changes
Have advanced cardiopulmonary disease
Patient population of Sandhams random study
High risk
> 60
ASA III/IV
Urgent or elective major surgery
T or F. The random study showed that PAC are more beneficial than standard care.
False. No benefit
In the randomized study, the PAC group showed an increase of
Pulmonary embolism
