Pulmonary Artery Catheter Flashcards
what is the pulmonary artery catheter designed to do?
be threaded through a central line catheter and into the pulmonary artery
how is a swan ganz catheter inserted?
through a central line with an introducer port
name the 5 ports on a swan ganz catheter
red balloon port white/clear proximal infusion port yellow PA distal port blue proximal injectate port (CVP) yellow thermistor port
red port swan ganz
BALLOON PORT
allows blood to carry the catheter into the pulmonary artery when
what does the balloon port decrease the risk of?
catheter coiling in the right ventricle as it is advanced
how many mL should the red ports balloon be filled with?
1.5mL
when should the balloon be inflated/ deflated?
inflated when advancing
ALWAYS deflate when withdrawing
why is the balloon deflated when withdrawing?
avoid possible myocardial or valve damage
PA distal port color
yellow
what are the two things that the PA distal port measures?
connected to transducer tubing measures
pulmonary artery pressure (PAP)
pulmonary capillary wedge pressure (PCWP)
PA proximal injectate port color and function
blue
monitors CVP when attached to trasducer tubing
how far does the proximal injectate port go to?
30cm
What is the other thing that the proximal injectate port used for?
injecting cold saline for thermodilution to calculate CO
proximal infusion port color and function
white or clear
connected to series of stopcocks used for drug infusions
how far does the proximal infusion port go to?
30cm
what does the yellow thermoster port connect to?
our anesthesia machine
what does the yellow thermistor port measure? (2)
blood temp
measures CO
what can be calculated from the CO calculated from thermistor port
SVR and PVR
see advanced hemodynamic PPT
what are the 8 clinical benefits of the swan ganz catheter?
1 measure PAP 2 measure CVP 3 measure PCWP 4 calculate CO 5 calculate SVR and PVR 6 deliver drug infusions 7 specialized types that allows insertion of pacing wires 8 removal of air embolism
3 steps to swan ganz catheter insertion
1 start central line with introducer port
2 hook up transducers to the swan
3 use waveform as guide to advance catheter until in pulmonary artery
what are the two central lines that are options for swan ganz insertion?
8.5F PSI (cordis)
9F MAC
when is the pumonary artery pressure waveform revealed?
where the distal tip of the catheter is in the heart
BE able to draw the different swan waveforms
SLIDE 33
when the catheter is advanced in the pulmonary artery what pressure is it sensing? (not wedged)
sensing pressure in the pulmonary artery coming from the forward flow of the right ventricle
when the catheter is advanced to the point of wedging against walls of pulm artery what pressure is it sensing?
pressure backing up from the left atrium
pulmonary capillary wedge pressure
what is another name for PCWP?
pulmonary artery occlusion pressure
does the pressure waveform change when the catheter wedges?
yes
what is PCWP a estimate of?
left atrial pressure
once the catheter wedges what do you not do?
do not advance any further
when do pulmonary artery catheters migrate distally?
cardiopulmonary bypass (CPBP)
two things to do during successful catheter placement
pull the catheter back 2-3cm during cardiopulmonary bypass
pull the catheter back if it wedges with <1.5cm air
4 tips for easier advancement of difficult swan insertion
1 ask pt deeply inhale as advancing
2 position pt head up with right lateral tilt
3 increase CO with inotropes
4 increase the stiffness of the catheter
how do you increase the stiffness of the catheter?
inject iced saline through the catheter
indications for the swan ganz insertion (2)
pt with low EF
pt with history of pulmonary hypertension
3 contraindications of swan ganz catheter
left bundle branch block
wolf parkinson white syndrome
tricuspid regurgitation
why is LBBB a contraindication
it could knock out the RBB and then introduce complete heart block
what can happen in WPW syndrome patients
induce hemodynamically intolerable tachyarrhythmias
5 complications of swan ganz catheter placement
1 same comp. as central line placements 2 pulmonary artery rupture 3 sustained ventricular ectopy 4 damage to cardiac structures 5 knotting on repeated insertion attempts
what allows you to have an a line, CVP and PAP on one set of transducer tubing
triple transducer, splits into three sections after spiking bag
should we use swans anymore?
Numerous studies have shown that patients managed pre- and intraoperatively with Swan-Ganz catheters do better than those managed without them, especially if there is time to optimize cardiac function
