| What are the potential complications of placing a pulmonary
artery (PA) catheter? |
Bleeding, infection, pneumo- or hemothorax, arrhythmias,
death |
| What arrhythmias occur during placement of PA
catheters? |
VT and heart block |
| What group of patients are prone to developing heart
block? |
Those with a LBBB |
| When do the arrhythmias usually occur? |
When the catheter passes through the RV |
| What are the normal filling pressures? |
|
| RA pressure or CVP |
0 to 8 mm Hg (mean) |
| RV pressure |
15 to 30/0 to 8 mm Hg (systolic/diastolic) |
| PA pressure |
15 to 30/3 to 12 mm Hg (systolic/diastolic) |
| PCWP |
3 to 12 mm Hg (mean) |
| What is the PCWP? |
Approximation of the LA and LV pressure during ventricular
filling (LVEDP) |
| What is the danger of overinflating the balloon while
measuring the PCWP? |
PA rupture, which can be fatal |
| What are three sources of error encountered when measuring
pressures with a fluid-filled catheter (e.g., arterial line, Swan-Ganz
catheter)? |
- Zeroing error
- Deterioration in frequency response—check for air in the catheter or
transducer
- Catheter impact—catheter impact is caused by a valve or other structure
hitting the catheter
- Catheter whip—as the catheter is hit by the pulse wave and motion is
generated, increasing systolic pressures and lowering diastolic pressures (i.e.,
the mean pressure is unaltered)
|
| How can you test for catheter whip? |
In arterial lines, by inflating a BP cuff proximal to the line;
as the cuff is deflated, the pressure that corresponds to the first pressure
wave recorded on the arterial line is the true systolic pressure. |
| What is the normal CO? |
5 ± 1 L/min |
| What is the normal CI? |
3 ± 0.5 L/min/m2 |
| How is SVR calculated? |
SVR = {[systemic BP (mean) – RA (mean)]/CO} × 80 dyne · cm ·
sec-5 |
| What is the normal SVR? |
1200 ± 300 dyne · cm · sec-5 |
| How is the SVRI calculated? |
SVRI = SVR × BSA |
| What is the normal SVRI? |
2100 ± 500 dyne · cm · sec-5 ×
m2 |
| How is the PVR calculated? |
PVR = [(PA mean – PC mean)/CO] × 80 dyne · cm ·
sec-5 |
| What is the normal PVR? |
100 ± 50 dyne · cm · sec-5 |
| How is the PVRI calculated? |
PVR × BSA |
| What is the normal PVRI? |
170 ± 70 dyne · cm · sec-5 ×
m2 |
| How are Wood units calculated? |
PVR = [PA (mean) – PCWP (mean)]/CO |
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