CVP and PA monitoring

Question 1

Where should the tip of the CVP catheter rest?

Answer 1

Just above the junction of the Vena Cava and the Right Atrium

Question 2

Where should the tip of the PA catheter reside?

Answer 2

In the pulmonary artery, distal to the pulmonary valve (25-35 cm from the VC junction)

Question 3

Highest risk of injuring the thoracic duct (chylothorax)?

Answer 3

Accessing the Left I J

Question 4

Most common complication while obtaining access?

Answer 4

Dysrhythmias

Question 5

Presentation of pulmonary artery rupture?

Answer 5

Hemoptysis

Question 6

When should you not float a PA catheter on a patient?

Answer 6

LBBB (can cause complete HEART BLOCK)

Question 7

RIJ to VC and RA junction

Answer 7

15 cm

Question 8

LIJ to VC and RA junction

Answer 8

20 cm

Question 9

Median basilic

Answer 9

Right: 40 cm
Left: 50 cm

Question 10

Subclavian (either side)

Answer 10

10 cm

Question 11

RA (PA)

Answer 11

0-10 cm

Question 12

RV (PA)

Answer 12

10-15 cm

Question 13

Pulmonary Artery (catheter tip cm)

Answer 13

15-30 cm

Question 14

PAOP position (tip)

Answer 14

25-35 cm

Question 15

RA contraction

Answer 15

a wave
(just after P wave (atrial depolarization)

Question 16

Tricuspid valve elevation into the RA

Answer 16

c wave
(just after QRS complex, ventricular depolarization)

Question 17

Downward movement of the contracting RV

Answer 17

X descent (ST segment)

Question 18

Passive filling of the RA

Answer 18

v wave
(just after T wave begins, ventricular depolarization)

Question 19

RA empties through the open tricuspid valve

Answer 19

Y descent
(after T wave ends)

Question 20

Normal CVP in an adult?

Answer 20

1-10 mmHg

Question 21

Hypervolemia, tricuspid stenosis/regurg, pulmonary HTN, cardiac tamponade, PEEP, RV failure, transducer BELOW phlebostatic axis (effect on CVP?)

Answer 21

Factors that INCREASE CVP

Question 22

Low CVP is almost always caused by:

Answer 22

Hypovolemia or the transducer is moved ABOVE the zero point

Question 23

CVP should be zeroed at:

Answer 23

The phlebostatic axis (4th intercostal space mid anterorposterior level)

Question 24

A transducer placed below the zero point does what?

Answer 24

OVERestimates CVP

Question 25

CVP should be measured at….

Answer 25

END-EXPIRATION

Question 26

CVP is a function of:

Answer 26

1. Intravascular volume 2. Venous tone 3. RV compliance

Question 27

Causes of LOSS of A-wave?

Answer 27

A-fib and V-pacing in asystole

Question 28

Causes of LARGE a-wave

Answer 28

tricuspid stenosis, diastolic dysfunction, AV dissociation

Question 29

Causes of large V-wave

Answer 29

tricuspid regurgitation and RV papillary muscle ischemia and acute increase of intravascular volume

Question 30

What happens when tip of PA catheter moves beyond pulmonic valve?

Answer 30

Diastolic pressure RISES

Question 31

Waveforms in PAOP (wedge) Pressure

Answer 31

a wave: caused by LA systole c wave: mitral valve elevation into LA during LV systole v wave: caused by passive LA filling

Question 32

Normal pressures of PA catheter measurement

Answer 32

RA: 1-10 mmHg RV: systolic 15-30, diastolic 0-8 mmHg PAP: systolic 15-30, diastolic 5-15 mmHg PAOP: 5-15 mmHg

Question 33

Aortic valve insufficiency causes PAOP to....

Answer 33

UNDERESTIMATE LVEDV

Question 34

PAOP OVERestimates LVEDP

Answer 34

MVR/stenosis, left-to-right cardiac shunt, tachycardia, PEEP, COPD, pulmonary HTN

Question 35

Which lung zone should the tip of pulmonary artery catheter be placed?

Answer 35

Zone 3

Question 36

Thermodilution Underestimates CO

Answer 36

Injectate volume too HIGH Injectate solution too COLD

Question 37

Thermodilution Overestimates CO

Answer 37

injectate volume too LOW injectate solution too HOT partially wedged PAC Thrombus on tip of PAC

Question 38

Unable to predict CO

Answer 38

Intracardiac Shunt Tricuspid Regurgitation

Question 39

4 variables mixed venous oxygen is dependent on?

Answer 39

1. CO 2. O2 consumption 3. Hgb 4. Hemoglobin saturation

Question 40

Factors that DECREASE SvO2?

Answer 40

Increased O2 consumption: stress, pain, thyroid storm, shivering, fever Decreased O2 delivery: decreased SaO2, Hgb, or CO

Question 41

Factors that DECREASE SvO2?

Answer 41

Decreased O2 consumption: hypothermia, cyanide toxicity Increased O2 delivery: O2 therapy, increased Hgb, CO