PA Catheter Basics - Stanford University
PA Catheter Basics
Indications
- Dx: Cardiogenic vs. Distributive shock; Cardiogenic vs. Non-cardiogenic Edema
- Management of Heart Failure
- Peri-operative management
Features:
-110 cm, 7 French, 2 ports, balloon, thermistor
- Insert via R. IJ/ L. subclavian; Sail effect of balloon
[pic]
|Normal Pressures |[pic] |
|- Fall during inspiration/rise with expiration | |
|-Read pressures at end of expiration (intrathoracic P | |
|= atmospheric P) | |
| | |
|RA – 2-8mm Hg | |
| | |
|RV – 15-30/2-8mmHg | |
| | |
|PA – 15-30/6-12mm Hg | |
| | |
|PCWP – 6-12 mm Hg | |
Management:
-Must insert under fluoroscopy if recent (3mo) PPM/ICD or LBBB.
-When wedging, inflate balloon slowly to 1.5cm
-Always remember to leave balloon deflated
Problems during insertion:
- Can not advance into pulmonary artery: usually due to large RV
- Ventricular arrhythmias –50% of placements, withdraw, no rx unless sustained
- CHB – transvenous pacing
- Unable to wedge – true cause unknown (non-uniform inflation), use PAD x PHTN
|Abnormal Waveforms |[pic] |
| | |
|Canon a-waves | |
| | |
| | |
| | |
| | |
|Large v-waves | |
| | |
| | |
| | |
| | |
| | |
|Over - Wedging | |
Hemodynamic Parameters
- Correct for Size: BSA (m2) = [Ht (cm) + Wt (kg) – 60] / 100 usu 1.6-1.9
- CI = CO/BSA NL 2.4-4.0, thermodilution vs. Fick
[pic]
- R=(Pin – Pout)/Q Hydraulic Analogy to Ohm’s Law (R=∆V/I)
- SVR = (MAP – CVP)/CO NL 700-1600 dynes*sec/cm5
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