Pulmonary Artery Catheter, Monitoring, Etc

Question 1

Indications for Pulmonary Artery Monitoring

Answer 1

Cardiac Output (C.O)
Left ventricle filling pressures (LVEDP)
Calculate SVR, PVR, SV, Shunt, O2 content
Pulmonary status (PAP, PCWP, RVP)
Mixed venous blood samples (SvO2)

Question 2

Specific indications for PA catheter (pt situations)

Answer 2

Shock state
Pulmonary edema (cardio and non-cardio)
Pulmonary vascular disease
MI complicaition
ARDS
Fluid management

Question 3

Complications with PA

Answer 3

Pneumothorax
Air emboli
Rupture valve 
Hemorrhage
Knotting
Thrombus
Infection
Endocardium damage
Pulmonary Infarct
Balloon rupture

Question 4

PA catherization absolute contraindication

Answer 4

Tricuspid valve stenosis

LBBB

Question 5

What are the 3 vascular system components?

Answer 5

Arterial system - conductance
Capillary system - exchange
Venous system - capacitance

Question 6

What is positive inotropism?

Answer 6

Stimulates the sympathetic system

Increases contractility and increased stroke volume

Question 7

What is negative inotropism?

Answer 7

Stimulates the parasympathetic system

Decreases contractility and decrease in SV

Question 8

Rate is affected by an extrinsic (aka central control mechanism), what does that mean?

Answer 8

it involves the CNS and humoral agents

Adrenergic stimulation, release of norepinephrine = dilation of the cholinergic receptors (on surface of cells)

Question 9

Stroke volume is affected by preload, afterload and contractility. These are intrinsic controls, what does that mean?

Answer 9

It is local control. It alters perfusion to meet metabolic needs. Blood flow will increase to the affected area.

Question 10

What is the ideal Zone to insert the PA catheter?

Answer 10

Zone 3. It has more perfusion. Capillary/Venous and arterial have a more continuous flow and exceed alveolar.

Question 11

Data that can be obtained from a PA catheter

Answer 11

obtained: CVP, PCWP, PAP, RAP, SvO2, Temp, C.O,

Calculated: SVR, PVR, SV, SI, Shunt, CaO2, CvO2, DO2, VO2

Question 12

When the catheter is wedged and you see a PCWP reading, should you deflate the balloon or not? Explain why

Answer 12

In order to get a continuous PAP reading, the balloon must be deflated for the blood to flow at a constant speed. You also need to deflate the balloon otherwise it will cause an emboli

Question 13

Name the diseases and clinical states that will cause PCWP inaccuracies

Answer 13

PCWP lower:

• Aortic regurgitation
• decreased left ventricular compliance

PCWP higher:

• Presence of thoracic tumors
• PPV, PEEP
• increase in left ventricular compliance

Question 14

Reference point for transducer

Answer 14

Mid-axillary line at the 4th intercostal space
near the right atrium

Also referred to as: Phlebostatic Axis