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RTH 236 > Pulmonary Artery Catheters 1 > Flashcards

Pulmonary Artery Catheters 1 Flashcards

1
Q

What is hemodynamic monitoring?

A

Refers to physical characteristics of blood flow (flow rate- CO, blood pressure, vascular resistance)

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2
Q

Right ventricle perfuses the ___ resistance, ___ pressure central circulation

A

low; low

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3
Q

Left ventricle perfuses the ___ pressure, ___ resistance peripheral (systemic) circulation

A

high; high

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4
Q

2/3 of blood is in the ___ system, 1/4 in the ___ system and the remaining is in _____

A

venous; arterial; pulmonary vasculature

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5
Q

What are the indications for PACs?

A
  • right heart function
  • pulmonary function
  • left heart function
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6
Q

What do you monitor for right heart function?

A
  • CVP = RAP = RVEDP and RV function
  • some catheters monitor RV directly
  • assess pulmonary and tricuspid functions
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7
Q

What do you monitor for pulmonary function?

A
  • PASP, PADP, PAMP, PCWP
  • flow through the PVR and shunt equations
  • measures PvO2 and SvO2
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8
Q

What do you monitor for left heart function?

A
  • PAWP = LVEDV and LV function

- measures CMO and SVR

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9
Q

What is the PAC equipment?

A
  • catheter
  • tubing not > 4 feet
  • stop cocks
  • TYCO pressure bag
  • pressure transducer
  • amplifier
  • recording device
  • ECG
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10
Q

What will pressure be if the transducer is above the patient?

A

falsely low

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11
Q

What will pressure be if the transducer is below the patient?

A

falsely high

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12
Q

What are the PAC insertion sites?

A
  • internal jugular (most common and right is safest)
  • subclavian (right is more common)
  • basilic
  • cephalic
  • femoral
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13
Q

What is the procedure for inserting a PAC?

A
  • operative permit
  • sterile gloves, gown, mask and cap
  • three minute scrub with betadine
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14
Q

What is the catheter design?

A
  • made of PVC and softens are body temp
  • usually 110 cm in length (ped in 60)
  • 4-8 french in diameter
  • available in 2-6 lumens
  • black bands at 10 cm intervals
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15
Q

What is the distal port?

A
  • labeled PA distal. farthest from you and ends at the tip of the catheter
  • continuously monitors pressure and must be infused with heparinized solution
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16
Q

What is the distal port used for?

A
  • PAP (balloon down)
  • PWP (balloon up)
  • obtain mixed venous samples
  • injecting medications
17
Q

What is the balloon?

A

it allows the catheter to float with blood through the heart

18
Q

What is the balloon used for?

A
  • insertion

- allows catheter to float and “wedge” when you want a PCWP reading

19
Q

What is the proximal port?

A
  • terminates 30 cm tip

- opening lies in right atrium

20
Q

What is the proximal port used for?

A
  • RA pressure - like CVP
  • administration of drugs and fluids
  • sample blood
  • injection of saline for CMO reading
21
Q

What is the thermistor?

A

opens 4-5 cm from tip

22
Q

What is the thermistor used for?

A
  • monitors blood temperature

- needed for CMO measurement

23
Q

What is the oxygen saturation port used for?

A

direct measurement of venous saturation

24
Q

What are the additional ports that some PACs have?

A
  • artrial/ventricular cardiac pacing
  • continuous cardiac output
  • ventricular port VIP
  • right ventricular ejection fraction
25
Q

What does VIP stand for and what is it?

A

venous infusion port. has two openings in the right atrium (most commonly used one for monitoring, one for giving)

26
Q

What is the right atrium waveform?

A
  • normal 2-6mmHg
  • measured from distal port during insertion
  • anatomically RA filling when tricuspid is closed and RVEDP when tricuspid is open
27
Q

Where are RA pressures read after insertion?

A

Proximal port

28
Q

What is the right ventricle waveform?

A
  • RV sys 20-30/RV dia 2-6mmHg
  • only measured during catheter insertion
  • diastolic pressure remains the same
  • systolic increases greatly
  • recognize catheter advancement by change in sys
  • anatomically RVEDP should correspond to RA pressure and RVSP should correspond with PASP
29
Q

What is the pulmonary artery waveform?

A
  • PAP sys 20-30/PA dia 6-15mmHg
  • PAP mean 10-20 mmHg
  • recognize catheter advancement by change in diastolic pressure
30
Q

What is pulmonary wedge pressure waveform?

A
  • PCWP 4-12mmHg
  • also called PCOP or PWP
  • catheter is wedged in pulmonary artery
  • blood flow is blocked
  • tip looks ahead and reflects LAMP during systole and LVEDP during diastole
31
Q

What is over wedging?

A

Prolonged wedging or hyperinflation create occlusion of the catheter tip and distort accurate measurements

32
Q

T/F: wedge pressure can be higher than pulmonary diastolic pressure

A

False; can never be higher

33
Q

What changes when you advance the catheter from the right ventricle to the pulmonary artery?

A

Diastolic pressure

34
Q

Why are the pulmonary artery and ventricular systole the same?

A

The semilunar valves are open

35
Q

What can only be seen during diastole?

A

Left ventricle

36
Q

What can only be seen during systole?

A

Left atrium

37
Q

What zone do you want the catheter and why?

A

Zone 3 because that’s where the blood is

38
Q

What pressure is read during insertion?

A

Right ventricular

RTH 236 (21 decks)

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