Pulmonary Artery Catheter Flashcards
How is a Swan Ganz catheter inserted?
Through a central line with an introducer port
Best insertion location for pulmonary artery catheter
R IJ
Second best insertion location for pulmonary artery catheter
L subclavian vein
Purpose of red port
To carry the catheter to the pulmonary artery when advanced
Balloon port characteristics
- Located proximal to the distal tip of the catheter, red port connected to the 3ml balloon syringe
- Balloon should only be inflated when advancing
- Balloon should not be filled with more than 1.5 ml of air
- Balloon should be deflated when withdrawing to avoid possible myocardial or valve damage
Innermost lumen that goes all the way to the distal tip of the catheter
PA distal port, yellow
Connected to transducer tubing to monitor pulmonary artery pressure and pulmonary capillary wedge pressure
PA distal port, yellow
Goes to 30 cm mark of pulmonary artery catheter, connected to transducer tubing for CVP monitoring
Can be used to inject cold saline for thermodilution
Proximal injectate port, blue
Goes to 30 cm mark of pulmonary artery catheter, connected to series of stopcocks that are used to run drug infusions to the heart
Proximal infusion port, white
Allows measurement of blood temperature, cardiac output
Thermistor port, yellow
Benefits of the Swan Ganz catheter
- Measure pulmonary artery pressure
- Measure central venous pressure
- Measure pulmonary capillary wedge pressure
- Calculate cardiac output
- Calculate SVR and PVR
- Deliver drug infusions
- Insert pacing wires
- Withdraw air emboli
How to insert Swan Ganz catheter
- Start a central line with introducer port
- Hook up pressure transducers (CVP and PAP)
- Inflate balloon and advance into pulmonary artery, using waveform as guideline
Waveform at R atrium
5-12 mmHg
20-25 cm at skin
Waveform at R ventricle
15-30/0-8 mmHg
30-35cm at the skin
Waveform at pulmonary artery
15-30/5-15 mmHg
40-55cm at the skin
Waveform at pulmonary artery wedge
5-15 mmHg
50-60 cm at the skin
What is the pulmonary capillary wedge pressure?
- When the balloon “wedges” the catheter can no longer sense pressure coming from the forward flow of the right ventricle, it can only sense pressure backing up from the left atrium
- Estimate of L atrial pressure
What is pulmonary artery pressure?
When the balloon is advancing, it is sensing pressure in the pulmonary artery coming from the forward flow of the right ventricle
What should you do after successful catheter placement?
- Pull the catheter back 2-3 cm in cardiopulmonary bypass
2. Pull the catheter back if it wedges with <1.5 ml air
Tips for easier advancement during difficult Swan insertion
- Ask the patient to inhale deeply as you advance
- decreases intrathoracic pressure and increases blood flow - Position the patient head up, with right lateral tilt
- minimizes catheter contact with the heart - Increase the cardiac output with inotropes
- epi, dobutamine, etc - Increase the stiffness of the catheter
- inject iced saline through catheter
Indications for Swan Ganz insertion
- Patients with low EF
2. Patients with hx pulmonary HTN
Contraindications for Swan Ganz insertion
- LBBB
- WPW syndrome
- Tricuspid regurgitation
Complications of Swan Ganz catheter insertion
- Same as central line: air embolism, arterial puncture, infection
- Pulmonary artery puncture
- Sustained ventricular ectopy
- Damage to cardiac structures
- “knotting” on repeated insertion attempts
What is a triple transducer?
3 transducers (CVP, PAP, Arterial line) all supplied by one pressure bag and one set of transducer tubing
What do the yellow, blue and white ports do?
Yellow: PAP transducer tubing
Blue: CVP transducer tubing
White: Infusions
