Pulmonary Artery Catheters 2 Flashcards
What are lung problems?
- non cardiogenic pulmonary edema (aspiration, gram - sepsis, ARDS)
- excessive PEEP level
- pulmonary emboli
- alveolar hypoxia leading to pulmonary artery constriction (COPD)
- general shunt hypertension
- shunt
What are right heart problems?
- tricuspid stenosis or regurgitation
- right sided myocardial infarction
- cardiac tamponade
- ruptured septum
What are left heart problems?
- cardiogenic pulmonary edema
- mitral regurgitation/stenosis
- aortic stenosis
- MI to left ventricle
- constrictive pericarditis
- patient ductus arteriosus
- arteriosclerotic heart disease
What should PADP be compared to PCWP so it increases PVR?
> 3-5
What causes an increase in PVR?
- acidosis
- hypercarbia
- hypoxia
- less common: pulmonary emboli, alveolar septal defect, surgical removal
What are complications of vein cann?
- local infection
- bleeding and hematoma
- pneumo/hemothorax
- injury to trachea/thoracic duct
- damage to vein
What are complications during placement?
- cardiac arrhythymias
- local infections, PA rupture
- pulmonary emboli
- balloon rupture and air emboli
- intercardiac knotting
What are problems that disrupt accuracy in a waveform?
- dampened (decrease in amp due to air or kink)
- catheter whip (movement of catheter)
- pressure values (transducer not in correct place)
- respiratory effect (low press during inhalation)
- PEEP
- zones
- migration
How does peep affect the waveform?
- causes zones to shift
- compliant lungs transmit more peep
- 5cmh2o peep = 1cmh2o added to measurement
What determines cardiac output?
- stroke volume
- heart rate
What factors affect stroke volume?
- preload
- contractility
- afterload
What is the normal cardiac output?
75 x 75 = 5400
What is preload?
The stretching of muscle fibers in the ventricle
What is contractility?
The inherent ability of the myocardium to contract normally. The greater the stretch the more forceful the contraction
What is afterload?
The pressure that the ventricular muscles must generate to overcome the higher pressure in the aorta to get the blood out of the heart
How does heart failure affect preload?
Increases
How do adrenergic drugs affect left ventricular afterload?
Increase
How do calcium channel blockers affect contractility?
Decrease
What are vascular factors?
- exercise and venous blood flow
- peripheral vascular resistance (high pressure and increase in left heart work)
- blood volume (decreased then low co, increased them high co)
How does an increase in contractility affect the heart?
- increase in CO
- decrease pressure
How does a decrease in contractility affect the heart?
- decreased CO
- higher pressure
How does increase blood volume affect the heart?
- increased CO
- increased pressure
How does low blood volume affect the heart?
- decrease CO
- decreased pressure
How does uncompensated failure affect the heart?
- decreased pressure
- decreased CO
How does compensated failure affect the heart?
- still below normal
- increased pressure
- increased CO
What does hypovolemia cause?
Low pressure, low CO
What does sepsis cause?
Low pressure, high CO
What does hypervolemia cause?
High pressure, high CO
What does CHF cause?
High pressure, low CO
How do you know if therapy is effective?
Does intervention change the relationship between intravascular space and blood volume?
What are left physical findings?
- dyspnea
- crackles
- orthopnea
- JVD
- hepatomegaly
- pedal edema
What are physical findings of the right heart?
- pedal edema
- PCWP will not be as high
- no crackles
- no pulmonary veins/capillary issues
What does an increase in preload cause?
- increased fluid volume
- vasoconstriction
What does decreased preload cause?
- hypovolemia
- vasodilation
What does increased afterload cause?
- hypovolemia
- vasoconstriction
What does decreased afterload cause?
-vasodilation
What is the primary goal of all hemodynamic therapeutic intervention?
To optimize cardiovascular function in order to ensure adequate tissue oxygenation
