Pulmonary Artery Catheter Flashcards Preview

I&M for Anesthesia - Fall 2013 > Pulmonary Artery Catheter > Flashcards

Flashcards in Pulmonary Artery Catheter Deck (44):
0

What is a pulmonary artery catheter used for?

Hemodynamics assessment of patients with acute myocardial infarction

1

What size is the standard PAC?

7, 7.5, or 8 Fr
110 cm in length

2

The syringe that comes with the PAC is only

1.5 ml

3

How many lumens does the PAC have?

4-5

4

Pulmonary artery blood temperature is measured through the

Temperature thermistor

5

CVP monitoring, fluid, and drug administration is done through the

Proximal port

6

The distal port is for

PAP monitoring

7

The variable infusion port is used for

Fluid and drug afministration

8

The balloon is located at

The catheter tip

9

PAC insertion is facilitated using a

Large bore introducer catheter

10

The PAC is inserted through _______ with the patient in

The subclavian or IJ
Trendelenburg

11

Prior to PAC insertion, the transducer is

Connected to the distal port
Leveled and zeroed

12

What kind of pressure monitoring during PAC section is required to determine the location of the catheter tip?

Continuous

13

The balloon is inflated when the hub of the introducer is at

20 cm

14

Usually around 45-55 cm, the ________ is obtained

Pulmonary capillary wedge pressure (PCWP)

15

Normal values and wave configurations produced by PAC

View chart

16

Indications for PAC

Assess volume status
RV or LV failure
Pulmonary hypertension
Valvular disease
Cardiac surgery

17

Hemodynamics parameters

Chart

18

Recorded from the proximal port of the PAC int he superior vena cava or right atrium

CVP

19

CVP equals right ventricular end diastolic pressure (RVEDP) when

No obstruction exists between atrium and ventricle
CVP also equals right atrium pressure (RAP)

20

Pulmonary artery pressure (PAP) is measured at the tip with ballon

Deflated
Reflects right ventricle function, pulmonary vascular resistance, and left atrium filling pressures

21

Recorded from the tip of catheter with balloon inflated

Pulmonary capillary wedge pressure (PCWP)
PCWP = LAP - LVEDP (when no obstruction exists between atrium and ventricle)

22

Cardiac output is calculated using

Thermodilution technique

23

What is the thermodilution technique?

Using the thermistor to record the change in temperature of blood flowing through pulmonary artery when cold fluid is injected into the right atrium
Measure of cardiac output

24

Formula for cardiac index

CI = CO/BSA

25

Formula for stroke volume index

SVI = CI/HR

26

Systemic vascular resistance

Reflects impedance of the systemic vascular tree
SVR = 80 x (MAP-CVP)/CO

27

Pulmonary vascular resistance

Reflects impedance of pulmonary circuit
PVR = 80 x (PAM - PCWP)/CO

28

Left ventricular stroke work index (LVSWI)

LVSWI = (MAP - PCWP) x SVI x 0.136

29

Right ventricular stroke work index (RVSWI)

RVSWI = (PAM - CVP) x SVI x 0.136

30

Oxygen delivery

DO2 = CI x 1.34 x Hgb x SaO2

31

Mixed venous oxygen saturation is the oxygen saturation in

Pulmonary artery blood
Used to detect impaired tissue oxygenation

32

Oxygen uptake

VO2 = CI x 1.34 x Hgb x (SaO2-SvO2)

33

What are the benefits to PAC?

Effect on treatment decisions
Preoperative catheterization
Perioperative monitoring

34

PAC complications of establishment of central venous access

Bleeding
Neuropathy
Air embolism
Pneumothorax
Accidental puncture of adjacent arteries

35

PAC complications of pulm artery catheterization

Dysrrhythmias
Right bundle branch block
Minor increase in tricuspid regurgitation

36

A RBBB can lead to a complete heart block if the patient already has

Preexisting LBBB

37

PAC complications of pulm catheter residence

Thromboembolism
Mechanical, catheter knots
Pulmonary infarction
Infection, endocarditis
Endocardial damage, cardiac valve injury
Pulmonary artery rupture

38

How frequently does pulmonary artery rupture occur? Mortality rate?

0.03-0.2%
41-70% mortality

39

ASA guidelines for PAC states appropriateness depends on

Patient
Surgery
Practice setting

Basically anything that can influence hemodynamics instability should be taken into account

40

According to Task Force in Pulm Artery Catheterization, PAC is necessary in surgical patients who

Have a high risk of complications from hemodynamics changes
Have advanced cardiopulmonary disease

41

Patient population of Sandhams random study

High risk
> 60
ASA III/IV
Urgent or elective major surgery

42

T or F. The random study showed that PAC are more beneficial than standard care.

False. No benefit

43

In the randomized study, the PAC group showed an increase of

Pulmonary embolism