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Carnegie > right heart Cath notes > Flashcards

right heart Cath notes Flashcards

1
Q

these are what type of caths?
thermodilution, S-tip, VIP, Paccport, Oximetry

A

swans

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2
Q

list the type of swans

A

thermodilution, S-tip, VIP, Paccport Oximetry

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3
Q

proximal Ra port blue
distal pa port yellow
balloon arrow lock and 1.5 CC syringes
thermistor red cap
pacing venous infusion marker band distances
are types of

A

ports

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4
Q

name the ports
port blue
port yellow
arrow lock and 1.5 CC syringes
thermistor red cap

A

proximal Ra port blue
distal pa port yellow
balloon arrow lock and 1.5 CC syringes
thermistor

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5
Q

name the type of ports on a swan

A

proximal distal balloon thermistor pacing venous infusion marker band distances

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6
Q

name an angiographic catheter

A

Berman

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7
Q

flushing, stopcocks, sterile sleeve 0.021 wire these are for

A

prepping a catheter

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8
Q

what type of wire is prepared in catheter prep

A

0.021

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9
Q

what so you sample/measure

A

pressures saturations cardiac output

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10
Q

complications?

A

pulmonary hemorrhage infection air embolism ectopic anaphylaxis for latex balloon

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11
Q

assembling _____________flush bag and ________

A

pressurized;transducer

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12
Q

all swan catheters can obtain pressures when connected to a __________or a single ________

A

manifold;transducer

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13
Q

some swan cathetes can have ____________for angiography images (lings burman catheters pr PWP catheters

A

contrast injectate

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14
Q

swan Ganz catheters have an injectable port to obtain ____________by thermodilution

A

cardiac output

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15
Q

swan Ganz catheters have an injectable port to obtain cardiac output by

A

thermodilution

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16
Q

chf pulmonary htn cardiomyopathies cardiac output determine valvular heart disease these are all ____________of rhc

A

indications

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17
Q

what are the access sites for rhc

A

axillary, jugular, PICC, midline, femoral, snuff box

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18
Q

usually don’t do axillary access for rhc because of

A

pneuomothorax complication

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19
Q

rhc is usually right ________access site

A

brachial vein

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20
Q

pneumothorax, hemothorax, tracheal perforation are all _________of rhc _______-

A

complications; access

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21
Q

stimulation of the rvot-ventricular arrhythmias av blocks RBBB atrial arrhythmias pulmonary rupture pulmonary infarct knot PAC are all _____________-of rhc _________-

A

complications; intracardiac

22
Q

what would you see on an EKG as an indication you are in the ventricles

A

PVCs

23
Q

term for waveforms

A

hemodynamics

24
Q

what are the only vessels that can go to 0mmhg

A

lv and RV

25
Q

what vessel will never go to 0mmhg

A

PA

26
Q

balloon can’t stay longer than ________inflated in the _________-

A

30s;PC wedge

27
Q

list the normal pressure ranges
ra_______
rv systolic _________
RV diastolic ________
PA systolic _________
PA diastolic __________
PA wedge ________

A

Ra 0-8
RV s 20-30
RV d 0-8
pa s 20-30
pa d 8-15
pa wedge 8-12

28
Q

the PC wedge pressures should equal to the

A

LA

29
Q

swan french size

A

6-7.5

30
Q

guide wire for swan should be less than

A

0.025

31
Q

each single marker band= _______-cm

A

10

32
Q

each double thick marker band =______cm

A

50

33
Q

the Paccport style swan includes

A

RV port to accept chandler pacing probe

34
Q

what swan is used for venous approach

A

s-tip

35
Q

thermodilution outputs are preformed with

A

injectate set and computer connection

36
Q

this catheter is
accepts contrast, measures pressures
no temp port
use for pulmonary angiograms
measures pressures sample oxygen sats

A

Berman angiographic catheter/PWP catheter

37
Q

what is used for pulmonary angiograms

A

Berman angio Cath or PWP Cath

38
Q

can swans be used for angiographic cathetrs, why

A

no, lumens are too small to accommodate sticky contrast

39
Q

fill in the steps for catheter prep
1. ______ports, close _________
2. ______balloon
3. measure _______to _____ (30cm from ________)
4. attach to ________
5. Test __________probe
6. attach ______________if swan is to be left in place post procedure

A
  1. Flush ports, close stopcocks
  2. Test balloon
  3. Measure length to heart (30 cm from femoral)
  4. Attach to transducer
  5. Test temperature probe
  6. Attach Septi-Shield sterile sleeve if Swan is to be
    left in place post procedure
40
Q
  1. Flush ports, close stopcocks
  2. Test balloon
  3. Measure length to heart (30 cm from femoral)
  4. Attach to transducer
  5. Test temperature probe
  6. Attach Septi-Shield sterile sleeve if Swan is to be
    left in place post procedure
    these are steps for
A

catheter prep

41
Q
  1. Inflate with air (or carbon dioxide if R-L shunt
    present)
  2. Observe depth markers
    a. RA @ 30 cm
    b. RV @ 50 cm
    c. PA @ 60 cm
  3. PVC’s likely during transit through RV
  4. Possible problems
    a. Coiling in a chamber rather than advancing
    indicated by increasing depth markers with
    unchanging pressure waveform
    b. Float from IVC to RA to SVC instead of
    turning towards tricuspid valve. Patient may feel
    balloon in neck.
    c. Vessel spasm may be treated with
    nitroglycerine or verapamil
  5. Attached to pressurized flush device (saline with
    or without heparin at a rate between 3 to 8 ml/hr)
  6. Secure catheter, sterile sleeve and introducer
    sheath with 2-0 silk suture.
  7. Cover with sterile dressing
    these are steps for
A

advancing the cath

42
Q

advancing catheter
1. _______ with air (or ___________ if R-L shunt
present)
2. Observe depth markers
a. RA @ ____ cm
b. RV @ ____ cm
c. PA @ ____ cm
3. PVC’s likely during transit through ____
4. Possible problems
a. _____ in a chamber rather than advancing
indicated by increasing depth markers with
__________ pressure waveform
b. Float from IVC to RA to SVC instead of
turning towards _______ valve. Patient may feel
balloon in ______.
c. Vessel spasm may be treated with
_________ or ________
5. Attached to pressurized flush device (______ with
or without heparin at a rate between 3 to 8 ml/hr)
6. Secure catheter, sterile sleeve and introducer
sheath with ______ silk suture.
7. Cover with sterile dressing

A
  1. Inflate with air (or carbon dioxide if R-L shunt
    present)
  2. Observe depth markers
    a. RA @ 30 cm
    b. RV @ 50 cm
    c. PA @ 60 cm
  3. PVC’s likely during transit through RV
  4. Possible problems
    a. Coiling in a chamber rather than advancing
    indicated by increasing depth markers with
    unchanging pressure waveform
    b. Float from IVC to RA to SVC instead of
    turning towards tricuspid valve. Patient may feel
    balloon in neck.
    c. Vessel spasm may be treated with
    nitroglycerine or verapamil
  5. Attached to pressurized flush device (saline with
    or without heparin at a rate between 3 to 8 ml/hr)
  6. Secure catheter, sterile sleeve and introducer
    sheath with 2-0 silk suture.
  7. Cover with sterile dressing
43
Q
  1. Locate femoral vein (NAVL – Nerve, Artery,
    Vein, Ligament)
  2. Rotate leg outward
  3. Prep, drape, anesthetize
  4. Use modified Seldinger technique
    a. 18 gauge Cook needle for access
    b. Venotomy enlarged using #11 scalpel blade
    these are steps for
A

percutaneous femoral venous approach

44
Q

fill in the blank
percutaneous femoral venous approach
1. Locate femoral vein (NAVL – Nerve, Artery,
Vein, Ligament)
2. Rotate leg _____
3. Prep, drape, anesthetize
4. Use_________technique
a. _____ gauge Cook needle for access
b. Venotomy enlarged using ____ scalpel blade

A
  1. Locate femoral vein (NAVL – Nerve, Artery,
    Vein, Ligament)
  2. Rotate leg outward
  3. Prep, drape, anesthetize
  4. Use modified Seldinger technique
    a. 18 gauge Cook needle for access
    b. Venotomy enlarged using #11 scalpel blade
45
Q
  1. May be either percutaneous or cutdown
  2. Turn patients head contralaterally to ease passage
    around shoulder
  3. May be necessary to remove pillow
    these are steps for
A

brachial approach

46
Q

B. Brachial approach
1. May be either __________ or ________
2. Turn patients _______ contralaterally to ease passage
around shoulder
3. May be necessary to remove ______

A

B. Brachial approach
1. May be either percutaneous or cutdown
2. Turn patients head contralaterally to ease passage
around shoulder
3. May be necessary to remove pillow

47
Q
  1. Avoid accidental puncture of carotid
  2. Site Rite ultrasound or Doppler Smart Needle may
    aid access in difficult cases
  3. Remove pillow
  4. May help to elevate feet to enhance venous return
    these are steps for
A

internal jugular approach

48
Q

internal jugular approach
1. Avoid accidental puncture of _____
2. Site Rite ultrasound or Doppler Smart Needle may
aid _____ in difficult cases
3. Remove ______
4. May help to elevate _____ to enhance venous return

A
  1. Avoid accidental puncture of carotid
  2. Site Rite ultrasound or Doppler Smart Needle may
    aid access in difficult cases
  3. Remove pillow
  4. May help to elevate feet to enhance venous return
49
Q
  1. Rarely used in cath lab due to danger of
    pneumothorax or bleeding complications
  2. Turn patient’s head contralaterally
    these are steps for
A

subclavian approach

50
Q

subclavian approach
1. _______ used in cath lab due to danger of
_____________ or bleeding complications
2. Turn patient’s head __________

A
  1. Rarely used in cath lab due to danger of
    pneumothorax or bleeding complications
  2. Turn patient’s head contralaterally
51
Q

RHC is venous access

A

true

52
Q
A

Carnegie (5 decks)

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