Pulmonary Artery Catheter Flashcards by Alex Sextro

what is the pulmonary artery catheter designed to do?

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

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how is a swan ganz catheter inserted?

through a central line with an introducer port

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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

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red port swan ganz

BALLOON PORT

allows blood to carry the catheter into the pulmonary artery when

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what does the balloon port decrease the risk of?

catheter coiling in the right ventricle as it is advanced

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

1.5mL

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when should the balloon be inflated/ deflated?

inflated when advancing

ALWAYS deflate when withdrawing

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why is the balloon deflated when withdrawing?

avoid possible myocardial or valve damage

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PA distal port color

yellow

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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)

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PA proximal injectate port color and function

blue

monitors CVP when attached to trasducer tubing

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how far does the proximal injectate port go to?

30cm

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

injecting cold saline for thermodilution to calculate CO

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proximal infusion port color and function

white or clear

connected to series of stopcocks used for drug infusions

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how far does the proximal infusion port go to?

30cm

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what does the yellow thermoster port connect to?

our anesthesia machine

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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