Pulmonary Artery Catheters 1

Question 1

What is hemodynamic monitoring?

Answer 1

Refers to physical characteristics of blood flow (flow rate- CO, blood pressure, vascular resistance)

Question 2

Right ventricle perfuses the ___ resistance, ___ pressure central circulation

Answer 2

low; low

Question 3

Left ventricle perfuses the ___ pressure, ___ resistance peripheral (systemic) circulation

Answer 3

high; high

Question 4

2/3 of blood is in the ___ system, 1/4 in the ___ system and the remaining is in _____

Answer 4

venous; arterial; pulmonary vasculature

Question 5

What are the indications for PACs?

Answer 5

• right heart function
• pulmonary function
• left heart function

Question 6

What do you monitor for right heart function?

Answer 6

• CVP = RAP = RVEDP and RV function
• some catheters monitor RV directly
• assess pulmonary and tricuspid functions

Question 7

What do you monitor for pulmonary function?

Answer 7

• PASP, PADP, PAMP, PCWP
• flow through the PVR and shunt equations
• measures PvO2 and SvO2

Question 8

What do you monitor for left heart function?

Answer 8

• PAWP = LVEDV and LV function

- measures CMO and SVR

Question 9

What is the PAC equipment?

Answer 9

• catheter
• tubing not > 4 feet
• stop cocks
• TYCO pressure bag
• pressure transducer
• amplifier
• recording device
• ECG

Question 10

What will pressure be if the transducer is above the patient?

Answer 10

falsely low

Question 11

What will pressure be if the transducer is below the patient?

Answer 11

falsely high

Question 12

What are the PAC insertion sites?

Answer 12

• internal jugular (most common and right is safest)
• subclavian (right is more common)
• basilic
• cephalic
• femoral

Question 13

What is the procedure for inserting a PAC?

Answer 13

• operative permit
• sterile gloves, gown, mask and cap
• three minute scrub with betadine

Question 14

What is the catheter design?

Answer 14

• made of PVC and softens are body temp
• usually 110 cm in length (ped in 60)
• 4-8 french in diameter
• available in 2-6 lumens
• black bands at 10 cm intervals

Question 15

What is the distal port?

Answer 15

• labeled PA distal. farthest from you and ends at the tip of the catheter
• continuously monitors pressure and must be infused with heparinized solution

Question 16

What is the distal port used for?

Answer 16

• PAP (balloon down)
• PWP (balloon up)
• obtain mixed venous samples
• injecting medications

Question 17

What is the balloon?

Answer 17

it allows the catheter to float with blood through the heart

Question 18

What is the balloon used for?

Answer 18

• insertion

- allows catheter to float and “wedge” when you want a PCWP reading

Question 19

What is the proximal port?

Answer 19

• terminates 30 cm tip

- opening lies in right atrium

Question 20

What is the proximal port used for?

Answer 20

• RA pressure - like CVP
• administration of drugs and fluids
• sample blood
• injection of saline for CMO reading

Question 21

What is the thermistor?

Answer 21

opens 4-5 cm from tip

Question 22

What is the thermistor used for?

Answer 22

• monitors blood temperature

- needed for CMO measurement

Question 23

What is the oxygen saturation port used for?

Answer 23

direct measurement of venous saturation

Question 24

What are the additional ports that some PACs have?

Answer 24

• artrial/ventricular cardiac pacing
• continuous cardiac output
• ventricular port VIP
• right ventricular ejection fraction

Question 25

What does VIP stand for and what is it?

Answer 25

venous infusion port. has two openings in the right atrium (most commonly used one for monitoring, one for giving)

Question 26

What is the right atrium waveform?

Answer 26

- normal 2-6mmHg - measured from distal port during insertion - anatomically RA filling when tricuspid is closed and RVEDP when tricuspid is open

Question 27

Where are RA pressures read after insertion?

Answer 27

Proximal port

Question 28

What is the right ventricle waveform?

Answer 28

- RV sys 20-30/RV dia 2-6mmHg - only measured during catheter insertion - diastolic pressure remains the same - systolic increases greatly - recognize catheter advancement by change in sys - anatomically RVEDP should correspond to RA pressure and RVSP should correspond with PASP

Question 29

What is the pulmonary artery waveform?

Answer 29

- PAP sys 20-30/PA dia 6-15mmHg - PAP mean 10-20 mmHg - recognize catheter advancement by change in diastolic pressure

Question 30

What is pulmonary wedge pressure waveform?

Answer 30

- PCWP 4-12mmHg - also called PCOP or PWP - catheter is wedged in pulmonary artery - blood flow is blocked - tip looks ahead and reflects LAMP during systole and LVEDP during diastole

Question 31

What is over wedging?

Answer 31

Prolonged wedging or hyperinflation create occlusion of the catheter tip and distort accurate measurements

Question 32

T/F: wedge pressure can be higher than pulmonary diastolic pressure

Answer 32

False; can never be higher

Question 33

What changes when you advance the catheter from the right ventricle to the pulmonary artery?

Answer 33

Diastolic pressure

Question 34

Why are the pulmonary artery and ventricular systole the same?

Answer 34

The semilunar valves are open

Question 35

What can only be seen during diastole?

Answer 35

Left ventricle

Question 36

What can only be seen during systole?

Answer 36

Left atrium

Question 37

What zone do you want the catheter and why?

Answer 37

Zone 3 because that's where the blood is

Question 38

What pressure is read during insertion?

Answer 38

Right ventricular