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

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download