Indications for PAC?
Assess volume status Assess RV/LV failure Assess Pulm HTN Assess valvular disease Cardiac surgery
Where is CVP measured?
proximal port of PAC in superior vena cava or in R atrium (CVP = RAP)
Where/how is Pulmonary Artery Pressure measured? What does it reflect?
At the tip of the PAC with balloon deflated. Reflects RV function, PVR and LA filling P
Where/how is Pulmonary Capillary Wedge Pressure measured?
At the tip of the PAC catheter with the balloon inflated
PAC has a thermistor for temperature measuring, also a port for CVP measuring. Y/N?
Y and Y
Continuous pressure monitoring during PAC insertion is required to determine location of the catheter tip. Y/N?
When should you inflate the balloon?
when the 20cm mark is at the hub of the introducer.
How far should you insert the PAC?
Advance the PAC until the pulmonary capillary wedge pressure (PCWP) is obtained, usually around 45-55cm at the hub.
Understand the change of pressure wave forms as you advance the catheter
Get yourself familiar with these values
What’s the oxygen delivery equation?
DO2=CO/BSA*CaO2; (CO/BSA=CI, cardiac index)
What’s Mixed Venous Oxygen Saturation (SVO2) and what’s it used for
Oxygen saturation in pulmonary artery blood; Used to detect impaired tissue oxygenation
What’s Oxygen uptake and its equation?
Rate of oxygen taken up from the systemic microcirculation; VO2 = CI x 1.34 x Hgb x (SaO2 - SVO2)
Benefits from PAC?
Effect on Treatment Decisions: information gathered from PA catheter data can beneficially change therapy;
Preoperative Catheterization: information gathered prior to surgery can lead to cancellation or modification of surgical procedure, thereby preventing morbidity and mortality;
Perioperative Monitoring: provides invasive hemodynamic monitoring in the surgical setting
PAC complications during establishment of central venous access?
Accidental puncture of adjacent arteries; Bleeding; Neuropathy; Air embolism; Pneumothorax
PAC complications during advancing the catheter?
Dysrhythmias; Premature ventricular and atrial contractions; Ventricular tachycardia or fibrillation; Right Bundle Branch Block (RBBB); In patients with preexistinh LBBB, can lead to complete heart block; Minor increase in tricuspid regurgitation
PAC complications when encountered catheter residence?
Thromboembolism; Mechanical, catheter knots; Pulmonary Infarction; Infection, Endocarditis; Endocardial damage, cardiac valve injury; Pulmonary Artery Rupture 0.03-0.2% incidence, 41-70% mortality