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40 Cards in this Set

  • Front
  • Back
What is pulmonary artery pressure monitoring used to assess?
1. Right sided intracardiac pressures
2. Left sided intracardiac pressures
3. CO
4. Mixed venous saturation
What is reflected by the inflated balloon being wedged in PA?
1. Left ventricular end diastolic volume (LVEDV)
2. Only in the absence of pulmonary dz or valvular dysfunction
What are the indications for PA pressure monitoring?
1. Major surgery with large fluid shifts (open heart)
2. Ventricular dysfunction
3. CHF
4. Severe valvular dz
5. Conduction disturbances requiring pacing (paced port swan)
6. CABG
7. AAA
8. Liver or lung transplant
9. Shock states (sepsis, hypovolemia)
10. Burns over large body surface area
How do you know when the PA cath is in the RV?
You see V-tach on monitor
What are some of the complications for PA cath insertion?
1. Cardiac dysrhytmias
2. Catheter kinking/knotting
3. RA/RV perforation
4. PA rupture
5. Pneumothorax
6. Pulmonary infarction
- with persistant wedging
7. Bacterial endocarditits
What is the normal range for RA=RVEDV=CVP?
1-8 mmHG
What is the range for RV systolic pressure?
15-25 mmHg
What is the range for RV diastolic pressure?
1-8 mmHg
What is the range for PA systolic pressure?
15-25 mmHg
What is the range for PA diastolic pressure?
8-15 mmHg
What is the range for PCWP=LVEDV?
6-12 mmHg
What variations in pressures can hypervolemia and vasoconstriction cause?
1. Increase CVP
2. Increase CI
3. Increase PCWP
4. Increase PAP
How would you treat the hypervolemia or vasoconstricted state?
1. Diuretics
2. Restrict fluids
What variations in pressure can hypovolemia cause?
1. Decrease CVP
2. Decrease CI
3. Decrease PCWP
4. Decrease PAP
How would you treat the hypovolemia state?
Replete volume with crystalloids or colloids
What variations in pressure can LV failure or increase afterload cause?
1. Increase/decrease in CVP
2. Decrease CI
3. Increase PCWP
4. Increase PAP
How would you treat the LV failure or increase afterload state?
1. Inotropes
2. Alpha adrenergic antagonists
What variations in pressure can pulmonary edema cause?
1. Increase CVP
2. Decrease CI
3. Increase PCWP
4. Increase PAP
How would you treat the pulmonary edema state?
Diuretics
What variation in pressure can RV failure or increase preload?
1. Increase CVP
2. Decrease CI
3. Decrease PCWP
4. Decrease PAP
How would you treat the RV failure or increase preload state?
Vasodilators
What is the phlebostatic axis?
Located by drawing an imaginary line from the fourth intercostal space at the right side of the sternum intersecting with the mid axilla
What anatomic location does the phlebostatic axis correlate with?
Right atrium
Where should the CVP transducer be leveled to?
1. Phlebostatic axis
2. RA
What is a venous air embolus?
When operative site is above the level of the heart, there is a possibility of air entrainment into the systemic circulation
What can a venous air embolus lead to?
1. Hypoxia
2. Hypercarbia (in blood)
3. Bronchoconstriction
4. Hypotension
5. CV collapse (ultimately)
What are some devices used to detect venous air emboulus?
1. TEE
2. Transthoracic doppler
3. EtCO2
4. PA catheter
5. Esophageal stethoscope
How does a TEE detect a VAE?
1. Air is visualized in heart as "fireflies"
2. Should see bubbles in the RA
How does a transthoracic doppler detect VAE?
"Millwhell" murmur
How does EtCO2 detect a VAE?
Will have a sudden decrease
How does a PA cath detect a VAE?
1. It doesn't detect it
2. It can be used to promptly aspirate the air from the venous circulation
3. When detected by an esophageal stethoscope
How does an esophageal stethoscope detect a VAE?
"Millwheel" murmer
Which method of VAE detection is the most direct and sensitive?
TEE
What are the treatments for VAE?
1. Ask surgeon to flood or pack field
- saline, wet sponges, bone wax
2. D/C N2O and give 100% O2
3. Aspirate blood/air from CVP cath
4. Support hemodynamics
- pressors, fluids, inotropes
5. Place pt in left lateral position
- keeps air in right side of heart
- prevent entrance into arterial blood
- prevent migration of embolus into brain
When iserting a PAC at what marking on the catheter can you determine you are in the RA and able to inflate the PA balloon?
20 cm
What marking on the PAC can be determined to be in the RV?
30-35 cm
Is there a sudden increase in systolic pressure once you reach the RV with a PAC insertion?
Yes
At what PAC marking will you have a PA tracing and a sudden increase in diastolic pressure?
40-45 cm
At what PAC marking will the balloon wedge in the PA and a change in waveform will be seen?
50-55 cm
Should you keep the PAC balloon inflated at all times?
No, just when you need a measurement