PA Pressure w/ Swan-Ganz

Question 1

Label the following picture.

Answer 1

1) Big white connector = Thermistor connection
2) Orange wire = paceport connector
3) Yellow wire only = Tip of swan-ganz
4) Yellow wire with white connector = PA port
5) Blue wire = Proximal port
6) Red wire = Injection port for balloon

Question 2

How long is a a normal Swan Ganz catheter?

Answer 2

110 cm

Question 3

What can the paceport be used for (2)?

Answer 3

1. Pacing the right ventricle
2. As a venous infusion port

Question 4

A. What often occurs as a result of the catheter residing in both the atrium and ventricle?

B. If this issue does not resolve on its own, what can you do to fix it?

Answer 4

A. Ectopy

B. Give boluses of Lidocaine or start an infusion (to reduce the excitability)

Question 5

A. How many lumens does a typical Swan-Ganz cather have?

B. Name each of them.

Answer 5

A. 4 lumens

B. Thermistor, balloon, infusion, and distal lumens

Question 6

What curve do you get from the thermistor?

Answer 6

Thermodilution curve

Question 7

What pressure does the distal lumen give you?

Answer 7

PA/PCWP (pulmonary artery/pulmonary capillary wedge pressure)

Question 8

What does the proximal lumen give you?

Answer 8

RAP (right atrial pressure)

Question 9

What is the maximum volume you can inject into the bung stop (retard)?

Answer 9

1.5 cc

Question 10

How many centimeters from the PA distal end is the thermistor opening?

Answer 10

3 cm

Question 11

How many centimeters from the PA distal end is the RV port opening?

Answer 11

19 cm

Question 12

How many centimeters from the PA distal end is the proximal injectate port opening?

Answer 12

30 cm

Question 13

What main manufacturer makes the paceport catheter with the right ventricular port which allows for passage of a ventricular pacing wire?

Answer 13

Chandler (the Chandler Ventricular Pacing Probe)

Question 14

A. What is the external diameter of the Swan-Ganz catheter?

B. What is the minimum introducer size?

Answer 14

A. 7.5 French

B. 8.0 French (want this to be 0.5-1.0 French sizes larger than the catheter)

Question 15

Where do you place the introducer, and in what position should the patient be in when placing it?

Answer 15

Into the RIJV (like CVL) with patient in Trendelenburg

Question 16

What is passed over the guidewire (consists of two components)?

Answer 16

A percutaneous introducer consisting of a vessel dilator and sheath

Question 17

What does VIP stand for (part of the Swan-Ganz)?

Answer 17

Venous infusion port

Question 18

What change do you see in the waveform as you pass the catheter from the RA to the RV?

Answer 18

Sharp increase in “systolic” pressure

Question 19

As the catheter tip enters the pulmonary artery, a ____ may occur in the systolic wave, and the diastolic pressure will ____ in magnitude and will be ____-sloping.

Answer 19

dicrotic notch

increase

down-sloping

Question 20

With further advancement of the cather, the balloon will occlude blood flow and the tip will record the _____ pressure, which is characterized by what?

Answer 20

Will record the pulmonary artery occlusion pressure, characterized by disappearance of the “systolic” pressure wave and reappearance of venous a, c, and v waves

Question 21

When the ballon is inflated to occlude the pulmonary artery, the distal port of the catheter measures ___ which ordinarily reflects ___ pressure?

Answer 21

the venous backpressure downstream from the balloon

left atrial pressure

Question 22

Right ventriclular pressure shows a ___ systolic pressure than seen in the right atrium, although the end-diastolic pressure are ___ in these two chambers.

Answer 22

higher

equal

Question 23

Right ventricular systolic pressure = ?

Answer 23

RVSP = PASP (pulmonary artery systolic pressure)

Question 24

The pulmonary artery occlusion pressure (PAOP) = WEDGE pressure, which is also equal to what other two pressures?

Answer 24

LAP and LVEDP

Question 25

RAP equals what?

Answer 25

RVEDP

Question 26

RVEDP \< ?

Answer 26

PADP

Question 27

PADP is approximately equal to what two pressures?

Answer 27

LAP and LVEDP

Question 28

Pulmonary artery wedge pressure measurement creates a ____ of blood connecting the catheter tip to a junction point where flow resumes in the pulmonary veins near the left atrium.

Answer 28

static column of blood

Question 29

In order to provide an accurate measure of pumonary venous or left atrial pressure, the tip of the PA catheter must be wedged in which lung zone? Why?

Answer 29

Lung Zone 3 Because alveolar pressure must be the lowest pressure in the zone in order for the wedge pressure to reflect intravascular pressure instead of alveolar pressure. Zone 1: P(A) \> P(a) \> P(V) Zone 2: P(a) \> P(A) \> P(V) \*Zone 3: P(a) \> P(V) \> P(A)\*

Question 30

Pulmonary artery wedge pressure a-c and v waves occur ____ in the cardiac cycle than their counterparts on the right side of the heart seen in a CVP trace.

Answer 30

Later

Question 31

The LAP and CVP waveforms have nearly identical morphologies, but the CVP a wave slightly ____ the LAP a wave (temporal relationship between the two waveforms).

Answer 31

precedes

Question 32

True/False Pulmonary artery wedge pressure (PAWP) is a damped, delayed reflection of left atrial pressure (LAP).

Answer 32

True

Question 33

What causes the artifactual pressure peaks and troughs in the pulmonary artery pressure waveform?

Answer 33

Catheter tip motion

Question 34

A. What is overwedging of the pulmonary artery catheter? B. What does overwedging of the pulmonary artery catheter cause? C. Solution?

Answer 34

A. When the catheter tip impinges against the vessel wall, or balloon herniation over the catheter tip B. Artifactual waveforms (saw-toothed waveform) C. Immediately deflate the balloon and withdraw the catheter 1-2 cm. Slowly reinflate the balloon until waveform returns to normal

Question 35

Above what PA pressure should you cancel the case until the patient's pulmonary hypertension is under control?

Answer 35

Above PA pressures of 60 (under 40 is normal systolic PAP)

Question 36

You should minimize the number of PCWP measurements in which patient populations (3)?

Answer 36

1. Elderly 2. Anticoagulated 3. Pulmonary HTN

Question 37

If PA diastolic pressure is \< ___ mm Hg, use PA diastolic pressure rather than PCWP as an index of left ventricular filling pressure.

Answer 37

18 mm Hg

Question 38

Upon transition from the PA to the pulmonary capillary wedge pressure trace, what should you do?

Answer 38

Immediately stop inflation!

Question 39

Distances from RIJV insertion site to a) right atrium? b) right ventricle? c) pulmonary artery? d) pulmonary artery wedge?

Answer 39

RIJV is a) 20 cm from RA b) **_30_**-35 cm from RV c) 40-**_45_** cm from PA d) 50 cm from PAW \*if asked for one number instead of range, choose the bolded, underlined value

Question 40

Advantages of percutaneous cannulation of the central internal jugular vein?

Answer 40

1. Rapidly accessible 2. Does not interfere w/ CPR 3. Provides a straight route to the heart 4. Less restrictive to patient movement

Question 41

Disadvantages of percutaneous cannulation of the central internal jugular vein?

Answer 41

1. Air embolism, carotid artery puncture, &/or tracheal injury may occur 2. Pneumothorax (more common in the left than the right internal jugular vein) 3. Thoracic duct injury (left internal jugular vein only)

Question 42

Equation for Systemic Vascular Resistance

Answer 42

SVR = (MAP - RAP) / CO

Question 43

Equation for Pulmonary Vascular Resistance

Answer 43

PVR = (PAP - PCWP) / CO

Question 44

To convert HRU (Wood units, or hybrid resistance units) to ARU (absolute resistance units), multiply by \_\_\_?

Answer 44

HRU --\> ARU, multiply by 79.9

Question 45

What is normal range for PA end-diastolic pressure?

Answer 45

4-12 mm Hg

Question 46

What is normal range for pulmonary artery wedge mean pressure?

Answer 46

4-12 mm Hg

Question 47

What is normal range for LA mean pressure?

Answer 47

2-12 mm Hg

Question 48

What is normal range for LV end-diastolic pressure?

Answer 48

5-12 mm Hg

Question 49

True/False PA end-diastolic pressure is a good indicator of pulmonary artery wedge pressure--if no change in PAEDP, then there is no need to check PA wedge pressure.

Answer 49

True

Question 50

A. Normal range for CO (L/min)? B. Normal range for SV (mL)?

Answer 50

A. CO = 4.0-6.5 L/min (or 5.0) B. SV = 60-90 mL (or 75)

Question 51

What risk factors are associated with pulmonary artery perforation (6)?

Answer 51

1. Advanced age 2. Hypothermia 3. Pulmonary HTN 4. Female gender 5. Radiation therapy to the area (e.g. for breast cancer) 6. Deviations from standard insertion techniques

Question 52

Mechanisms of pulmonary artery perforation (3)?

Answer 52

1. Tip perforation of the vasculature 2. Eccentric balloon configuration propelling the balloon through the vessel wall 3. Balloon inflation disrupting the pulmonary artery (mean intraballoon pressure = 250 mm Hg)

Question 53

Go to answer

Answer 53

BOO!!!!!!