Pulmonary Artery Catheters 1 Flashcards
What is hemodynamic monitoring?
Refers to physical characteristics of blood flow (flow rate- CO, blood pressure, vascular resistance)
Right ventricle perfuses the ___ resistance, ___ pressure central circulation
low; low
Left ventricle perfuses the ___ pressure, ___ resistance peripheral (systemic) circulation
high; high
2/3 of blood is in the ___ system, 1/4 in the ___ system and the remaining is in _____
venous; arterial; pulmonary vasculature
What are the indications for PACs?
- right heart function
- pulmonary function
- left heart function
What do you monitor for right heart function?
- CVP = RAP = RVEDP and RV function
- some catheters monitor RV directly
- assess pulmonary and tricuspid functions
What do you monitor for pulmonary function?
- PASP, PADP, PAMP, PCWP
- flow through the PVR and shunt equations
- measures PvO2 and SvO2
What do you monitor for left heart function?
- PAWP = LVEDV and LV function
- measures CMO and SVR
What is the PAC equipment?
- catheter
- tubing not > 4 feet
- stop cocks
- TYCO pressure bag
- pressure transducer
- amplifier
- recording device
- ECG
What will pressure be if the transducer is above the patient?
falsely low
What will pressure be if the transducer is below the patient?
falsely high
What are the PAC insertion sites?
- internal jugular (most common and right is safest)
- subclavian (right is more common)
- basilic
- cephalic
- femoral
What is the procedure for inserting a PAC?
- operative permit
- sterile gloves, gown, mask and cap
- three minute scrub with betadine
What is the catheter design?
- 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
What is the distal port?
- labeled PA distal. farthest from you and ends at the tip of the catheter
- continuously monitors pressure and must be infused with heparinized solution
What is the distal port used for?
- PAP (balloon down)
- PWP (balloon up)
- obtain mixed venous samples
- injecting medications
What is the balloon?
it allows the catheter to float with blood through the heart
What is the balloon used for?
- insertion
- allows catheter to float and “wedge” when you want a PCWP reading
What is the proximal port?
- terminates 30 cm tip
- opening lies in right atrium
What is the proximal port used for?
- RA pressure - like CVP
- administration of drugs and fluids
- sample blood
- injection of saline for CMO reading
What is the thermistor?
opens 4-5 cm from tip
What is the thermistor used for?
- monitors blood temperature
- needed for CMO measurement
What is the oxygen saturation port used for?
direct measurement of venous saturation
What are the additional ports that some PACs have?
- artrial/ventricular cardiac pacing
- continuous cardiac output
- ventricular port VIP
- right ventricular ejection fraction
What does VIP stand for and what is it?
venous infusion port. has two openings in the right atrium (most commonly used one for monitoring, one for giving)
What is the right atrium waveform?
- normal 2-6mmHg
- measured from distal port during insertion
- anatomically RA filling when tricuspid is closed and RVEDP when tricuspid is open
Where are RA pressures read after insertion?
Proximal port
What is the right ventricle waveform?
- 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
What is the pulmonary artery waveform?
- PAP sys 20-30/PA dia 6-15mmHg
- PAP mean 10-20 mmHg
- recognize catheter advancement by change in diastolic pressure
What is pulmonary wedge pressure waveform?
- 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
What is over wedging?
Prolonged wedging or hyperinflation create occlusion of the catheter tip and distort accurate measurements
T/F: wedge pressure can be higher than pulmonary diastolic pressure
False; can never be higher
What changes when you advance the catheter from the right ventricle to the pulmonary artery?
Diastolic pressure
Why are the pulmonary artery and ventricular systole the same?
The semilunar valves are open
What can only be seen during diastole?
Left ventricle
What can only be seen during systole?
Left atrium
What zone do you want the catheter and why?
Zone 3 because that’s where the blood is
What pressure is read during insertion?
Right ventricular
