Hemodynamic Monitoring Flashcards Preview

CCP-C/FP-C Certification Review > Hemodynamic Monitoring > Flashcards

Flashcards in Hemodynamic Monitoring Deck (24):
1

Swan-Ganz Catheter

Used to measure how much pressure blood is under when it goes into the pulmonary artery.  Measurements of right heart afterload and left heart preload.  PAC and Swann utilize same site (subclavian).

2

Swan-Ganz Important Notes

  • distal tip used to measure pressures
  • Do not exceed 1.5cc air in distal cuff
  • Do not take wedge pressure readings for >15sec or 3 breaths
  • Take readings at end of exhalation
  • PA port only for monitoring/lab sample draw
  • Deflate balloon during transport - prevents inadvertant wedge

3

Swan-Ganz Pressure Readings

  • PAWP - Pulmonary Artery Wedge Pressure
  • PAOP - Pulmonary Artery Occlusion Pressure
  • PACP - Pulmonary Artery Capillary Pressure

4

Swan-Ganz Progression

  1. Subclavian to right atrium
  2. Passing into right ventricle
  3. Final destinationn pulmonary artery

5

Central Venous Pressure (CVP)

  • Right atrial pressure
  • Measures right heart preload
  • Normal = 2-6mmHg

6

Right Ventricular Pressure (RV)

  • 15-25mmHg systolic
  • 0-5mmHg diastolic
  • May or my not have a dicrotic notch on left
  • High amplitude

7

Pulmonary Artery Pressure (PA)

  • 15-25mmHg systolic
  • 8-15mmHg diastolic
  • Dicrotic notch on the right side
  • High amplitude

8

Pulmonary Artery Wedge Pressure (PAWP)

  • Measures right heart afterload
  • Measures left heart preload
  • 8-12mmHg
  • Low amplitude rolling waveform

9

Coronary Perfusion Pressure (CPP)

DBP - PCWP

50-60mmHg

10

Catheter Whip

  • If this shows, catheter needs to be floated from the RV into the PA or it could cause V-Fib
  • Inflate cuff wth 1.55cc air
  • Have the patient cough
  • Lay them on their side

11

Increased PA Pressure

  • Left ventricular failure
  • Liver failure (portal HTN)
  • Cor pulmonale (increased pulmonary vascular resistance)
  • Mitral regurgitation
  • Mitral stenosis

12

Cardiac Output Transducer

Hooked up to the Swan-Ganz catheter.  Placed at the phlebostatic axis.

13

Phlebostatic Axis

4th ICS, mid-axillary line

14

Overdamping

  • System is not dynamic
  • Kinked line
  • Obstruction in the tube

15

Underdamping

  • System is too dynamic
  • Pressure bag not full
  • Air in the line

16

Intra-Aortic Balloon Pump (IABP)

  • Indications - acute MI with cardiogenic shock post CABG
  • CI - aortic insufficiency/disease, severed peripheral vascular disease, aortic regurgitation
  • Can cause hemolysis, balloon breaks RBCs during inflation
  • Increases coronary perfusion, decreases workload

17

Cardiogenic Shock

  • PAWP > 18-20
  • Decreased UOP
  • SBP < 80mmHg

18

IABP Function

  • Timed off EKG or manual
  • Systole - Deflated
  • Diastole - Inflated

19

IABP Placement

  • Femoral artery towards the heart
  • Sits in the descending aorta, distal to left subclavian, above renal artery
  • Check placement: Left radial pulse (no pulse - left subclavian blocked), UOP (if decreased - blocking renal artery)
  • CXR confirmation

20

IABP Pearls

  • Power failure - manual pump q3-5min to prevent clotting
  • No need to purge when going to altitude
  • Ensure you have extra helium
  • Brown/rust colored flakes in tubing indicates rupture of tubing

21

IABP Late Deflation

Most Dangerous

Increased Afterload

Late Deflation = Lethal Dose

22

IABP Early Inflation

Dangerous

Causes aortic regurgitation

23

IABP Late Inflation

Causes sub-optimal coronary perfusion

24

IABP Early Deflation

Causes retrograde coronary blood flow