Hemodynamic Monitoring

Front 1

What is a Swan Ganz Catheter and what does it measure

Back 1

A Swan Ganz Catheter is used in Pulmonary Artery Catheterization, and its purpose is diagnostic.Allows for direct, simultaneous measurement of pressures in the right atrium and ventricle, the pulmonary artery, and the wedge pressure (preload of left ventricle).

Hint 1

catheter with an inflatable balloon at its tip, which can be inserted into the pulmonary artery via the right chambers of the heart. Inflation of the balloon enables indirect measurement of pressure in the left atrium.

Front 2

what is hemodynamic monitoring?

Back 2

measurement of pressure, flow, and oxygenation of blood within the cardiovascular system

Front 3

Steps to insert a Swan Ganz Catheter.

Back 3

Same as inserting the CVC, but also:
1. calibrate before insertion
2. flush all lumens prior to insertion
3. assist the physician with floating the Swan Ganz (inserted with the balloon down, balloon up in right atrium, then begin to monitor waveforms and HR)

Front 4

How does hemodynamic monitoring work?

Back 4

a tranducer is hooked into the patient through an IV line (central or arterial), and pressure tubing that hooks into an external machine.

Front 5

What is a central venous catheter and what does it measure?

Back 5

Central venous access is the placement of a venous catheter in a vein that leads directly to the heart (aka the neck, chest, or groin).

It measures the CVP.
It is also used as venous access when there are no other options, administration of drugs that cannot be given peripherally (inotropes, vasoactives), adminstration of hypertonic solutions such as TPN, hemodialysis and plasmaphoresis

Front 6

What are the indications for hemodynamic monitoring?
SHEMS-G

Back 6

Shock
Heart Failure
Evaluate Pharmacological Treatments
Myocardial Infarctoin
Surgery
Guide for therapy- fluid vs. diuretics

Front 7

What are indications for arterial monitoring?

Back 7

1. continuous blood pressure monitoring
2. frequent blood sampling

Front 8

What types of tubing are used?

Back 8

Triple Lumen Catheter, Swan Ganz Catheter, Arterial Lines

Front 9

How to place an arterial catheter.

Back 9

Preferred location is radial due to collateral circulation (other sites include brachial, femoral, and dorsalis pedis)
Perform an Allen's Test- assess the patency of the radial-ulnar arch.
DO NOT PUNCTURE if color return is over 7 seconds.
Continue to perform neurovascular checks distal to the arterial line.

Front 10

What does Central Venous Pressure measure and what is a normal reading?

Back 10

Preload of the right ventricle. thats why it is also known as Right Atrial Pressure (RAP)
4-8mmHg

Front 11

What kind of tubing does the CVP get its measurement from?

Back 11

The distal port of the triple lumen catheter, or the blue port of the Swan Ganz catheter

Front 12

What would cause a low CVP?

Back 12

hypovolemia

Front 13

What would cause a high CVP?

Back 13

fluid overload, left ventricular failure

Front 14

What does the Left Atrial Pressure (Wedge Pressure) measure and what is a normal reading?

Back 14

left ventricular preload (when the balloon is inflated)
6-12mmHg

Front 15

What type of tubing and what port do you use to measure the LAP(wedge) pressure?

Back 15

the distal portion of the Swan Ganz catheter (when the balloon is inflated)

Front 16

What causes a high LAP reading?

Back 16

fluid overload, ventricular failure

Front 17

What causes a low LAP reading?

Back 17

hypovolemia

Front 18

What are complications from a LAP?

Back 18

1. ischemia to the pulmonary artery, which can lead to necrosis (if the balloon is too inflated for too long)
2. pulmonary artery rupture from over inflation of the balloon (pt will bleed to death quickly)

Front 19

What is Cardiac Output, the formula, and what is a normal reading?

Back 19

HR x Stroke Volume = CO
it is the amount of blood ejected from the heart in one minute.
4-8L/min

Front 20

How is the equipment used to get a CO reading? (2 ways)

Back 20

it is measured by the Swan Ganz catheter two ways:
1. manual thermodilution where the RN will administer 10cc of cold NSS and see the reading. Do this several times and take an average
2. Continuous cardiac output monitoring which is done via machine

Front 21

What causes a low CO? (6)

Back 21

hypovolemia, HF, tachycardia, low contractility, cardiomyopathy, cardiogenic shock

Front 22

What causes a high CO?

Back 22

higher preload, fluid overload, medication therapy (positive inotropes, digoxin)

Front 23

What is the cardiac index, and what is the normal range? (how do you calculate it)

Back 23

The cardiac index is cardiac output according to body surface area (BSA). it is calculated as CO/BSA, and the normal range is 2.5-4.0L/min/m2.
*figure out the pts BSA using a height/weight chart

Front 24

What measures the systemic vascular resistance (SVR) and how do you find it?

Back 24

left ventricular afterload. it is calculated as ((MAP - CVP) x 80)/CO

-it is the pressure that the heart must squeeze AGAINST to get all of its blood out

Front 25

What causes a high SVR?

Back 25

vasoconstriction

Front 26

What causes a low SVR?

Back 26

vasodilation

Front 27

What does the Mixed Venous Oxygen Saturdation (SVO2) measure, and what is a normal reading?

Back 27

It reflects oxygenation at the tissue level.
Normal = 60-80

Front 28

How is the SVO2 measured?

Back 28

It is measured using fiber optics with special Swan Ganz or Triple Lumen Catheters.

Front 29

What causes a low SVO2?

Back 29

sepsis, increased BMR

Front 30

What causes a high SVO2?

Back 30

tissues aren't pulling the O2 off, which can result from too many blood transfusions. Or they could be receiving too much supplemental O2. Check how many liters are being given.

Front 31

How does SVO2 guide nursing care?

Back 31

Think critically here. Know what causes a high and low SVO2, and know how to fix those.
High- check how many liters they are geting, or think: why are the tissues using less oxygen?
Low: why could the tissues be needing more oxygen than normal?

Front 32

Complications of inserting a central line?

Back 32

Immediate vs. delayed

1. pneumothoraces can occur if the catheter goes in to far. can be spontaneous, or slight and symptoms creep up slowly. the
first sign is Tachypnea!!
2. Infection- duh
3. air embolism- rare
4. Hemorrhage- more common in the jugular vein
5. Arryhthmia- may occur when the wire comes into contact with the endocardium, but is resolved when the wire is pulled back

Front 33

Which port do you NEVER infuse through?

Back 33

The PA port

Front 34

What is a transducer?

Back 34

converts physiological events into electrical signals. to zero, turn the stop cock upward and remove the cap to atmospheric air

Front 35

What do you need to know to perform hemodynamic calibration?

Back 35

how to calibrate the system.
-use the phlebostatic axis for reference to obtain proper placement.
-every position change the patient has, the machine needs to be recalibrated!

Front 36

What is the phlebostatic axis?

Back 36

the level of the right atrium, which lies at the fourth intercostal space in the midaxillary line. The patient lies supine, with the head between 0 and 45 degrees.

Front 37

What are complications from an arterial catheter?

Back 37

Thrombosis or arterial inclusion, and infection