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Patient Monitoring/ Instrumentation Kristi > Pulmonary Artery Swan Ganz Catheter > Flashcards

Pulmonary Artery Swan Ganz Catheter Flashcards

1
Q

the pulmonary artery catheter is designed to be threaded through a _____ _____ catheter and into the ______ artery

A

central line

pulmonary

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2
Q

what type of central line do you need to place a pulmonary artery catheter

A

introducer port

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3
Q

what 2 veins are swan Ganz catheters placed

A
  1. Right IJ

2. Left subclavian

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4
Q

what color is the balloon port?

A

red

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5
Q

what is the function of the red port?

A

allows blood to “carry” the catheter into the pulmonary artery
-decreases the risk of coiling in the right ventricle

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6
Q

what is the red port connected to?

A

3 mL syringe

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7
Q

when should the balloon be inflated?

A

only when advancing

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8
Q

the balloon must always be _____ when the catheter is withdraw to avoid _____ or _____ damage

A

deflated
myocardial
valve

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9
Q

what is the max amount of air the balloon should be filled with?

A

1.5 mL

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10
Q

what color is the most distal port of the catheter

A

yellow

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11
Q

the port with the innermost lumen that goes all the way to the distal tip of the catheter

A

Pa distal port (yellow)

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12
Q

what is the yellow port connected to?

A

transducer tubing for monitoring

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13
Q

what does the swan Ganz catheter measure?

A
  1. Pulmonary artery Pressure (PAP)

2. Pulmonary capillary wedge pressure (PCWP)

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14
Q

what color is the proximal injectate port?

A

blue

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15
Q

at what mark on the catheter is the proximal injectate port located?

A

30 cm

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16
Q

what is the proximal injectate port connected too?

A

transducer tubing for CVP monitoring in the right atrium

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17
Q

which port is used to inject cold saline into the heart if using thermodilution to calculate cardiac output

A

proximal injectate port (blue)

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18
Q

what color is the proximal infusion port?

A

white/clear

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19
Q

what mark on the catheter is the proximal infusion port located?

A

30 cm

20
Q

what is the proximal infusion port connected to?

A

a series of stopcocks that are used to run drug infusion directly to the heart

21
Q

what color is the thermistor port?

A

yellow

22
Q

where does the thermistor port connect?

A

anesthesia monitor

23
Q

what are the 2 purposes of the thermistor port?

A
  1. measurement of blood temperature

2. measurement of cardiac output

24
Q

once cardiac output is measured by the thermistor port, ____ and _____ can be calculated

A

SVR and PVR

25
Q

8 clinical benefits of Pulmonary artery catheter

A
  1. Measures pulmonary artery pressure (PAP) when transducer is hooked up to distal yellow port
  2. can measure CVP if transducer is hooked up to blue proximal injectate port on Swan Ganz
  3. can measure pulmonary capillary wedge pressure if transducer is hooked up to yellow distal port on swan
  4. can calculate cardiac output by using the yellow thermodilution port
  5. can calculate systemic vascular resistance and pulmonary vascular resistance
  6. to deliver drug infusions through the white proximal infusion port
  7. insertion of pacing wires through extra ports
  8. air emboli can be withdrawn from the heart
26
Q

List the 3 steps of the Swan Ganz Catheter Insertion

A
  1. start a central line
  2. Hook up pressure transducers PAP and CVP to the Swan
  3. Using the pressure waveform as a guide, inflate the balloon and advance the Swan through the central line catheter until it arrives in the pulmonary artery
27
Q

what waveform reveals where the distal tip of the catheter is in the heart

A

pulmonary artery pressure waveform

28
Q

what pressure waveform and length from the skin is the swan in the right atrium?

A

5-12 mmHg

20-25 cm at the skin

29
Q

what pressure waveform and length from the skin is the swan in the right ventricle?

A

15-30 mmHg systolic
0-8 mmHg diastolic
30-35 cm at the skin

30
Q

what pressure waveform and length from the skin is the swan in the pulmonary artery?

A

15-30 mmHg systolic
5-15 mmHg diastolic
40-55 cm at the skin

31
Q

what pressure waveform and length from the skin is the swan at the pulmonary artery wedge?

A

5-15 mmHg

50-60 cm at the skin

32
Q

when the pulmonary artery catheter is being advanced into the pulmonary artery , where does it sense pressure of the blood flow?

A

senses pressure in the pulmonary artery coming from the forward flow of the right ventricle
-pulmonary artery pressure

33
Q

when the catheter is advanced to the point where the balloon wedges against the walls of the pulmonary artery, where does the distal tip sense blood pressure from?

A

pressure backing up from the left atrium

-pulmonary capillary wedge pressure

34
Q

PCWP is also known as

A

pulmonary artery occlusion pressure (PAOP)

35
Q

PCWP is an estimate of which blood pressure?

A

left atrial pressure

36
Q

pulmonary artery catheters migrate in which direction during cardiopulmonary bypass (CPBP)?
why is this a problem?

A
  • distally

- may cause the catheter to wedge without balloon inflation and may cause PA rupture

37
Q

what do you do once the pulmonary artery catheter wedges?

A

do not advance the catheter any further

38
Q

2 steps after successful catheter placement in cardiopulmonary bypass

A
  1. pull catheter back 2-3 cm after cardiopulmonary bypass

2. pull the catheter back if it wedges less than 1.5 cm of air

39
Q

4 tips for easier advancement during difficult Swan insertion

A
  1. ask patient to deeply inhale while you advance
  2. position the patient head up with a right lateral tilt
  3. increase the cardiac output with inotropes
    - epi, dobutamine
  4. increase the stiffness of the catheter with iced saline
40
Q

what is the advantage to asking the patient to inhale deeply during difficult swan insertion

A

decreases intrathoracic pressure and increases blood flow

41
Q

what is the advantage of the position of the patient head up with right lateral tilt during difficult Swan insertion?

A

minimizes catheter contact with the heart

42
Q

2 indications for a Swan Ganz catheter insertion

A
  1. Patients with a low EF

2. patients with a hx of pulmonary hypertension

43
Q

3 contraindications for Swan Ganz catheter insertion

A
  1. Left bundle branch block
    - if swan knocked out right bundle branch block it wold induce a complete heart block
    - external pacing abilities must be available
  2. Wolf Parkinson White syndrome (WPW)
    - can induce a hemodynamically intolerable tachyarrhythmia
  3. tricuspid regurgitation
44
Q

5 complications of Swan Ganz catheter

A
  1. same complications of central line placement
    - air embolism, arterial puncture
  2. pulmonary artery rupture
    - high mortality rate
  3. sustained ventricular ectopy
  4. damage to cardiac structures with the balloon
  5. “knotting” on repeated insertion attempts
45
Q

what is the function of the triple transducer?

A

3 transducers for arterial, PAP, and CVP can all be supplied by one pressure bag and one set of transducer tubing

46
Q

what is the function of the white port connecting to the stopcocks?

A

allows multiple lines from IV pumps to connect and infuse through the one white port

Patient Monitoring/ Instrumentation Kristi (4 decks)

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