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LANCE > Pulmonary Artery Catheter > Flashcards

Pulmonary Artery Catheter Flashcards

1
Q

what is the pulmonary artery catheter designed to do?

A

be threaded through a central line catheter and into the pulmonary artery

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2
Q

how is a swan ganz catheter inserted?

A

through a central line with an introducer port

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3
Q

name the 5 ports on a swan ganz catheter

A 
red balloon port
white/clear proximal infusion port
yellow PA distal port
blue proximal injectate port (CVP)
yellow thermistor port
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4
Q

red port swan ganz

A

BALLOON PORT

allows blood to carry the catheter into the pulmonary artery when

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5
Q

what does the balloon port decrease the risk of?

A

catheter coiling in the right ventricle as it is advanced

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6
Q

how many mL should the red ports balloon be filled with?

A

1.5mL

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7
Q

when should the balloon be inflated/ deflated?

A

inflated when advancing

ALWAYS deflate when withdrawing

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8
Q

why is the balloon deflated when withdrawing?

A

avoid possible myocardial or valve damage

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9
Q

PA distal port color

A

yellow

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10
Q

what are the two things that the PA distal port measures?

A

connected to transducer tubing measures
pulmonary artery pressure (PAP)
pulmonary capillary wedge pressure (PCWP)

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11
Q

PA proximal injectate port color and function

A

blue

monitors CVP when attached to trasducer tubing

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12
Q

how far does the proximal injectate port go to?

A

30cm

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13
Q

What is the other thing that the proximal injectate port used for?

A

injecting cold saline for thermodilution to calculate CO

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14
Q

proximal infusion port color and function

A

white or clear

connected to series of stopcocks used for drug infusions

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15
Q

how far does the proximal infusion port go to?

A

30cm

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16
Q

what does the yellow thermoster port connect to?

A

our anesthesia machine

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17
Q

what does the yellow thermistor port measure? (2)

A

blood temp

measures CO

18
Q

what can be calculated from the CO calculated from thermistor port

A

SVR and PVR

see advanced hemodynamic PPT

19
Q

what are the 8 clinical benefits of the swan ganz catheter?

A 
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
20
Q

3 steps to swan ganz catheter insertion

A

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

21
Q

what are the two central lines that are options for swan ganz insertion?

A

8.5F PSI (cordis)

9F MAC

22
Q

when is the pumonary artery pressure waveform revealed?

A

where the distal tip of the catheter is in the heart

23
Q

BE able to draw the different swan waveforms

A

SLIDE 33

24
Q

when the catheter is advanced in the pulmonary artery what pressure is it sensing? (not wedged)

A

sensing pressure in the pulmonary artery coming from the forward flow of the right ventricle

25
Q

when the catheter is advanced to the point of wedging against walls of pulm artery what pressure is it sensing?

A

pressure backing up from the left atrium

pulmonary capillary wedge pressure

26
Q

what is another name for PCWP?

A

pulmonary artery occlusion pressure

27
Q

does the pressure waveform change when the catheter wedges?

A

yes

28
Q

what is PCWP a estimate of?

A

left atrial pressure

29
Q

once the catheter wedges what do you not do?

A

do not advance any further

30
Q

when do pulmonary artery catheters migrate distally?

A

cardiopulmonary bypass (CPBP)

31
Q

two things to do during successful catheter placement

A

pull the catheter back 2-3cm during cardiopulmonary bypass

pull the catheter back if it wedges with <1.5cm air

32
Q

4 tips for easier advancement of difficult swan insertion

A

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

33
Q

how do you increase the stiffness of the catheter?

A

inject iced saline through the catheter

34
Q

indications for the swan ganz insertion (2)

A

pt with low EF

pt with history of pulmonary hypertension

35
Q

3 contraindications of swan ganz catheter

A

left bundle branch block
wolf parkinson white syndrome
tricuspid regurgitation

36
Q

why is LBBB a contraindication

A

it could knock out the RBB and then introduce complete heart block

37
Q

what can happen in WPW syndrome patients

A

induce hemodynamically intolerable tachyarrhythmias

38
Q

5 complications of swan ganz catheter placement

A 
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
39
Q

what allows you to have an a line, CVP and PAP on one set of transducer tubing

A

triple transducer, splits into three sections after spiking bag

40
Q

should we use swans anymore?

A

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

LANCE (17 decks)

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