Pulmonary artery catheter

Question 1

What do you need to insert a pulmonary artery catheter?

Answer 1

central line with introducer port

Question 2

Which port allows the catheter into the pulmonary artery when advanced?

Answer 2

Red

Question 3

What is the maximum amount of air that the PAC balloon should be filled with?

Answer 3

1.5 mL

Question 4

what should an anesthetist always do whenever the catheter is withdrawn?

Answer 4

DEFLATE the balloon

Question 5

innermost lumen that goes all the way to the distal tip of catheter

Answer 5

PA distal port YELLOW

Question 6

2 things the yellow distal port monitors

Answer 6

1. pulmonary artery pressure 2. pulmonary capillary wedge pressure

Question 7

what mark does the blue port of the pulmonary artery catheter go to?

Answer 7

30 cm mark

Question 8

port used to inject cold saline

Answer 8

proximal injectable port; blue port

Question 9

what does the blue port monitor?

Answer 9

CVP

Question 10

what is the proximal infusion port (white) connected to?

Answer 10

series of stopcocks and used to run drug infusions directly into the heart

Question 11

which port allows measurement of blood temperature and cardiac output?

Answer 11

thermistor port (yellow)

Question 12

when cardiac output is measure what two things can be calculated?

Answer 12

SVR and PVR

Question 13

8 functions of the swan ganz catheter

Answer 13

1. measures PAP 2. measure central venous pressure 3. measures pulmonary capillary wedge pressure 4. can calculate cardiac output 5. can calculate SVR and pulmonary vascular resistance 6. delivers drug infusions 7. insertion of pacing wires 8. withdrawing air emboli from the heart via a port on the pulmonary artery catheter

Question 14

describe what pulmonary capillary wedge pressure is

Answer 14

when the balloon wedges against the walls of the pulmonary artery and the distal tip of the catheter can no longer sense the pressure coming form the forward flow of the right ventricle and senses pressure backing up from the left atrium

Question 15

PCWP is an estimate of ___

Answer 15

left atrial pressure

Question 16

What should you do once the catheter wedges?

Answer 16

do NOT advance the catheter any further pull the catheter back 2-3 cm during cardiopulmonary bypass pull the catheter back if it wedges with <1.5 cm air

Question 17

4 ways for easier advancement during difficult swan insertion

Answer 17

1. ask pt to deeply inhale as you advance 2. position the patient head up with a right lateral tilt 3. increase the cardiac output with inotropes 4. increase the stiffness of the catheter

Question 18

2 indications for Swan Ganz catheter insertion

Answer 18

1. pts with low ejection fraction 2. pts with a history of pulmonary hypertension

Question 19

3 contraindications for Swan Ganz catheter insertion

Answer 19

1. left bundle branch block 2. wolf parkinson white syndrome 3. tricuspid regurgitation

Question 20

5 complications of swan ganz catheter placement

Answer 20

1. air embolism, arterial puncture, same as central line placement 2. pulmonary artery rupture 3. sustained ventricular ectopy 4. damage to cardiac structures 5. “knotting” on repeated insertion attempts