Pulmonary Artery Swan Ganz Catheter Flashcards
the pulmonary artery catheter is designed to be threaded through a _____ _____ catheter and into the ______ artery
central line
pulmonary
what type of central line do you need to place a pulmonary artery catheter
introducer port
what 2 veins are swan Ganz catheters placed
- Right IJ
2. Left subclavian
what color is the balloon port?
red
what is the function of the red port?
allows blood to “carry” the catheter into the pulmonary artery
-decreases the risk of coiling in the right ventricle
what is the red port connected to?
3 mL syringe
when should the balloon be inflated?
only when advancing
the balloon must always be _____ when the catheter is withdraw to avoid _____ or _____ damage
deflated
myocardial
valve
what is the max amount of air the balloon should be filled with?
1.5 mL
what color is the most distal port of the catheter
yellow
the port with the innermost lumen that goes all the way to the distal tip of the catheter
Pa distal port (yellow)
what is the yellow port connected to?
transducer tubing for monitoring
what does the swan Ganz catheter measure?
- Pulmonary artery Pressure (PAP)
2. Pulmonary capillary wedge pressure (PCWP)
what color is the proximal injectate port?
blue
at what mark on the catheter is the proximal injectate port located?
30 cm
what is the proximal injectate port connected too?
transducer tubing for CVP monitoring in the right atrium
which port is used to inject cold saline into the heart if using thermodilution to calculate cardiac output
proximal injectate port (blue)
what color is the proximal infusion port?
white/clear
what mark on the catheter is the proximal infusion port located?
30 cm
what is the proximal infusion port connected to?
a series of stopcocks that are used to run drug infusion directly to the heart
what color is the thermistor port?
yellow
where does the thermistor port connect?
anesthesia monitor
what are the 2 purposes of the thermistor port?
- measurement of blood temperature
2. measurement of cardiac output
once cardiac output is measured by the thermistor port, ____ and _____ can be calculated
SVR and PVR
8 clinical benefits of Pulmonary artery catheter
- Measures pulmonary artery pressure (PAP) when transducer is hooked up to distal yellow port
- can measure CVP if transducer is hooked up to blue proximal injectate port on Swan Ganz
- can measure pulmonary capillary wedge pressure if transducer is hooked up to yellow distal port on swan
- can calculate cardiac output by using the yellow thermodilution port
- can calculate systemic vascular resistance and pulmonary vascular resistance
- to deliver drug infusions through the white proximal infusion port
- insertion of pacing wires through extra ports
- air emboli can be withdrawn from the heart
List the 3 steps of the Swan Ganz Catheter Insertion
- start a central line
- Hook up pressure transducers PAP and CVP to the Swan
- 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
what waveform reveals where the distal tip of the catheter is in the heart
pulmonary artery pressure waveform
what pressure waveform and length from the skin is the swan in the right atrium?
5-12 mmHg
20-25 cm at the skin
what pressure waveform and length from the skin is the swan in the right ventricle?
15-30 mmHg systolic
0-8 mmHg diastolic
30-35 cm at the skin
what pressure waveform and length from the skin is the swan in the pulmonary artery?
15-30 mmHg systolic
5-15 mmHg diastolic
40-55 cm at the skin
what pressure waveform and length from the skin is the swan at the pulmonary artery wedge?
5-15 mmHg
50-60 cm at the skin
when the pulmonary artery catheter is being advanced into the pulmonary artery , where does it sense pressure of the blood flow?
senses pressure in the pulmonary artery coming from the forward flow of the right ventricle
-pulmonary artery pressure
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?
pressure backing up from the left atrium
-pulmonary capillary wedge pressure
PCWP is also known as
pulmonary artery occlusion pressure (PAOP)
PCWP is an estimate of which blood pressure?
left atrial pressure
pulmonary artery catheters migrate in which direction during cardiopulmonary bypass (CPBP)?
why is this a problem?
- distally
- may cause the catheter to wedge without balloon inflation and may cause PA rupture
what do you do once the pulmonary artery catheter wedges?
do not advance the catheter any further
2 steps after successful catheter placement in cardiopulmonary bypass
- pull catheter back 2-3 cm after cardiopulmonary bypass
2. pull the catheter back if it wedges less than 1.5 cm of air
4 tips for easier advancement during difficult Swan insertion
- ask patient to deeply inhale while you advance
- position the patient head up with a right lateral tilt
- increase the cardiac output with inotropes
- epi, dobutamine - increase the stiffness of the catheter with iced saline
what is the advantage to asking the patient to inhale deeply during difficult swan insertion
decreases intrathoracic pressure and increases blood flow
what is the advantage of the position of the patient head up with right lateral tilt during difficult Swan insertion?
minimizes catheter contact with the heart
2 indications for a Swan Ganz catheter insertion
- Patients with a low EF
2. patients with a hx of pulmonary hypertension
3 contraindications for Swan Ganz catheter insertion
- 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 - Wolf Parkinson White syndrome (WPW)
- can induce a hemodynamically intolerable tachyarrhythmia - tricuspid regurgitation
5 complications of Swan Ganz catheter
- same complications of central line placement
- air embolism, arterial puncture - pulmonary artery rupture
- high mortality rate - sustained ventricular ectopy
- damage to cardiac structures with the balloon
- “knotting” on repeated insertion attempts
what is the function of the triple transducer?
3 transducers for arterial, PAP, and CVP can all be supplied by one pressure bag and one set of transducer tubing
what is the function of the white port connecting to the stopcocks?
allows multiple lines from IV pumps to connect and infuse through the one white port
