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24 Cards in this Set
- Front
- Back
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Purpose of hemodynamic monitoring |
To evaluate the ability of the cardiovascular system to deliver blood flow and oxygenation to the tissues |
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How many lumen is the pulmonary artery catheter |
Four lumen catheter |
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Before transporting always ask for |
A current wedge |
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Wedge requirements |
500cc IV bag of NS with a 300 mmHg pressure bag
* bag must be pressurized to 300 mmHg to overcome the resistance of the flush device in the transducer and to deliver 3mL per hour through the catheter
*Zeroing the transducer tells the monitoring system that the atmospheric pressure is "zero" *low hemodynamic monitoring values may be caused by the transducer being above the phlebostatic axis, or by air bubbles or clots in the catheter |
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Low monitoring values may be from |
May be from the transducer being above the phlebostatic axis, or by air bubbles or clots in the catheter |
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Leveling the transducer |
Stopcock used to zero the system must be at the phlebostatic axis for all pressure readings If transducer is lower it will cause inaccurately high readings I'd transducer is higher it will cause inaccurately low readings (Tape to their side to stay level) |
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Transducer rules |
Most always be level with the right atrium Iv pole Phlebostatic axis... 4th intercostal space |
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Hemodynamic pressures |
•As cath approaches the right atrium it reflects the CVP and RA pressure •Balloon is inflated as is approaches the RA to float the catheter through the chambers of the heart •Aa balloon advances the waveform reflects the movement (or turbulance) of the catheter tip •difference b/w the RV pressure and the PA pressure is reflected in the diastolic pressure |
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CVP and RAP |
CVP = pressure in the great veins RAP = pressure in the R atria. Measured through the proximal port of the PA catheter CVP and RAP = reflect right ventricular end diastole pressure or preload. Normal values 2 to 8 mmHg |
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RVP |
Right ventricular pressure (pressure in the right ventricle) Seen during insertion of the PA catheter Normal : Systolic: 15 to 30 Diastolic: 0 to 8 |
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PAP |
Pulmonary artery pressure Reflects both right and left heart pressures Pressure in the pulmonary artery with the balloon deflated Normal: Systolic: 15 to 30 Diastolic: 5 to 15 |
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Causes of increased/decreased PAP |
Increased: hypervolemia, pulmonary HTN, PPV, cardiac tamponade, left ventricular failure Decreased: hypovolemia, vasodilation |
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Wedge |
Pulmonary artery wedge pressure (PAWP/PCWP/Wedge) Indirectly reflects left atrial pressure and left ventricular end diastolic pressure (LVEDP) |
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Obtaining wedge pressure |
Wedging of the catheter is only done to obtain the wedge pressure. Balloon is inflated with 1.5cc air and allowed to sail (wedge) into the distal branch of pulmonary artery where it's too narrow for balloon to pass. During occlusion the catheter sensing tips "see through" the pulmonary circulation (no valves) into the left atrium giving an indirect reflection of the left atrial pressure (LAP) Inflate balloon no longer than 15 to 30 seconds Use only air to inflate Never flush catheter in the wedge position Re-zero and recalibrate the transducer system after each wedge reading Normal values 4 to 12 |
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CO |
Cardiac output Amount of blood ejected by the ventricle each minute Evaluates cardiac function Normal is 4 to 8 L/min Measured by thermodilution HR x SV = CO |
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MAP normal range |
Mean arterial pressure (2DBP + SBP)÷3 70 to 100 mmHg |
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CVP normal range |
Central venous pressure 2 to 8 mmHg |
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PAD normal range |
Pulmonary artery diastolic pressure 5 to 15 mmHg |
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PAP normal range |
Pulmonary artery pressure 15 to 30 mmHg |
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Wedge normal range |
PCWP / PAWP / Wedge pressure 4 to 12 mmHg |
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CO normal range |
Cardiac output 4 to 8 L/min |
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CI normal range |
Cardiac index Cardiac output ÷ BSA 2.5 to 4 L/min |
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RVP normal ranges |
Right ventricular pressure Systolic 15 to 30 mmHg Diastolic 0 to 8 mmHg |
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If dampened waveform seen |
Cath might have spontaneously migrated forward. Encourage pt to cough, reposition and if persistent wedge is suspected and unable to be reduced pull catheter back until the issue has resolved into a PA waveform. When balloon is not inflated be prepared to pull catheter back. |
