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553 - Monitoring & CV Patient > Exam 7 - CVP / PAP > Flashcards

Exam 7 - CVP / PAP Flashcards

1
Q

CVP

A
  • very good estimation of RAP (pre-load of R heart)
  • pressure of blood in vena cava as it is returned
  • DIRECTLY assesses R heart function (RVEDP)
  • INDIRECTLY reflects venous return (therefore CO)
  • INDIRECTLY assesses L heart function
  • 2 to 6 mmHg
  • 65-80%
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2
Q

End RV diastole

A
  • RA and RV pressures are the same
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3
Q

Why CVP is an indirect assessment of L heart function

A
  • In healthy heart: LVEDP = (2 x RVEDP) + 2
  • RVEDP = CVP
  • Also good because it is in a circuit…just stuff in between
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4
Q

LV failure

A
  • RV can compensate temporarily until it gets burnt out
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5
Q

Factors that increase CVP

A
  • Hypervolemia (overfilling…we can do this!)
  • Forced exhalation
  • Tension pneumothorax
  • Heart failure
  • Pleural effusion
  • Decreased CO
  • Cardiac tamponade
  • PEEP / mechanical ventilation
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6
Q

Factors that decrease CVP

A
  • Hypovolemia (perfusionist underfill or bleeding)
  • Deep inhalation
  • Shock / vasodilation
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7
Q

Venous return and CO

A
  • Equal over time
  • Otherwise blood accumulates in pulmonary or systemic
  • increase in venous pressure increases venous return
  • blood flow through entire systemic circulation is both CO and venous return….they are equal
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8
Q

Blood volume in Veins

A
  • 64%
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9
Q

6 factors affecting venous return

A
  • Musculovenous pump (n/a on CPB)
  • Decresed venous capacitance (symp. Tone increases CVP/VR)
  • Respiratory pump (thoracic pressure negative when inhale)
  • Vena Cava compression (compressed cava lowers VR)
  • Gravity (standing decreases VR)
  • Pumping heart (no valve between atria and veins)
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10
Q

CVP insertion sites

A
  • catheter toward RA
  • 20cm: subclavian / internal-external jugular
  • 60 cm: femoral
  • also can do antecubital
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11
Q

CVP kit

A
  • Penetration syringe (can use big needle with this)
  • Dilator
  • Scalpel
  • guide syringe/needle
  • anesthesia syringe
  • needle holding sponge
  • big needle
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12
Q

Seldinger technique

A
  • Venous puncture w/ introducer needle
  • guide wire through needle –> needle removed
  • dilator passed over needle
  • dilator removed and catheter placed over wire
  • wire removed
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13
Q

Level to monitor CVP

A
  • Phlebostatic Axis = 4th intercostal space / mid-axillary

- level of atria

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14
Q

Complications of CVP

A
  • infection
  • air (Bad if PFO)
  • catheter shearing
  • thrombophlebitis (clots at insertion site)
  • Extravasation of fluid/drugs
  • pneumothorax
  • hemothorax
  • pericardial tamponade
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15
Q

CVP wave form

A
  • A: End Diastole / Atrial contraction (RVEDP)
  • C: Early systole / Tricuspid bulging
  • X: Mid systole / Atrial relax
  • V: Late systole / Systolic filling of atrium
  • Y: Early diastole / Early ventricle filling
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16
Q

CVP and CPB

A
  • heart is empty
  • CVP should be zero
  • If not….get better VR!
    - change height of Reservoir
    - cannulation?
    - reduce flow?
    - AVD
    - Kinetic assist venous drainage (KAVD)
    - VAVD
17
Q

Restricting Venous return line

A
  • Arterial flow > return
  • fills heart / increase preload / increase atrial pressure
  • total controls of pre-load
18
Q

Swan-Ganz catheter

A
  • PA catheter
  • original 2 lumens…now 6
  • more than 1 million used annually in US
19
Q

PA catheterization

A
  • through vein….through R side of heart…into PA
  • measures R heart and pulmonary pressures
    - Indirectly L heart pressures
  • invasive and can be risks
20
Q

PA cath indications

A
  • management of cardiopulmonary pressure/flows
  • cardiovascular function
  • surgical patients w/ systemic dysfunction
  • shock
  • pulmonary status
  • severe hypotension
21
Q

Contradictions for PA cath

A
  • severe coag defects (can cause hemorrhaging)
  • prosthetic right heart valve
  • endocardium pacemaker (knot up with electrode)
  • severe vascular disease
22
Q

Direct measurements from PA cath

A
  • CVP / RV pressure
  • PA pressures (PAWP)
  • CO
  • SvO2
23
Q

Indirect measurements from PA cath

A
  • SVR (MAP-CVP / CO x80)
  • PVR
  • CI (CO/BSA)
24
Q

Cardiac Output (Thermodilution)

A
  • 10cc cold saline (10C) injected into RA through proxml lumen
  • solution mixes w/ blood as it moves through RV into PA
  • thermistor registers change in blood temp
  • computer plots change in temp over time
  • calculates area under curve
  • perform 3-4 times and take average
  • Also have continuous CO catheters so you don’t have to inject fluid
    • uses thermal coil to heat blood to 44
25
Q

Fiber optic PA cath

A
  • measures SvO2
  • Reflected red light off of oxy/deoxy hemoglobin
  • computer gets % fraction
26
Q

PA pacing catheters

A
  • 3 atrial / 2 ventricular electrodes

- temporary pacing

27
Q

PA cath insertion sites

A
  • R internal jugular (preferred)
  • L internal jugular
  • subclavian
  • External jugular
  • femoral
  • antecubital
28
Q

RA to RV waveform

A
  • gets bigger

- RA pressure = RVEDP = RV filling = preload

29
Q

RV to PA waveform

A
  • get dicrotic notch (Pulmonary valve closure)
30
Q

PA to PCWP

A
  • balloon lodges into distal branch of PA
  • PCWP = LAP
  • Mean PCWP = LVEDP….filling pressure
  • Flat line waveform again
31
Q

PAWP

A
  • measures LV filling….LV preload
  • Mean PAWP reflects LA pressure = LVEDP
  • when balloon inflated….waveform flattens…deflate and it returns
32
Q

Over-wedging

A
  • continuously rising buildup of pressure
33
Q

PAP Waveform

A

1- Systolic ejection into PA (first valley)
2- Closure of Pulmonic valve (dicrotic notch)
3- End diastole (second valley)

34
Q

PA systolic pressure

A
  • shows RV function and pulmonary circ pressures
  • increased by:
    - L to R shunt (ASD/VSD)
    - pulmonary hypertension
    - COPD
35
Q

PA diastolic pressure

A
  • shows LV pressures
  • LVEDP
  • 6 to 12
  • increased by: Volume overload
    L heart dysfunction (failure, MR, MS, AS, AI)
  • decreased by: hypovolemia or severe tricuspid stenosis
36
Q

Problems getting hemodynamic data

A
  • body position to transducer
  • connection of transducer to catheter port
  • cardiac dysfunction
    - MI - PCWP goes up
    - LV dysfunction
    - Tachycardia
  • catheter whip
  • vent problems
37
Q

Complications of PA cath

A
  • arrhythmia
  • balloon rupture
  • knotting
  • infection
  • thrombus
  • pulmonary ischemia
  • damage to PA
  • cardiac perforation or tamponade

553 - Monitoring & CV Patient (10 decks)

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