CCT-Hemodynamic Monitoring

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  1. Lab Value for CVP
    2-6 mmHg
  2. Lab Value for RAP
    2-6 mmHg
  3. Lab Value for RVP
    15-25 / 0-5 mmHg
  4. Lab Value for PAP
    15-25 / 8-15 mmHg
  5. Lab Value for PAWP
    8-12 mmHg
  6. Lab Value for PCWP
    8-12 mmHg
  7. Lab Value for CO
    408 L/min
  8. Lab Value for CI
    2.5-4.2 L/min
  9. Lab Value for SV
    60-135 mL
  10. Lab Value for SI
    25-45 Ml/m2
  11. Lab Value for PVR
    50-250 dyn
  12. Lab Value for SVR
    800-1200 dyn
  13. Lab Value for LAP
    4-12 mmHg
  14. PAS correlates to what part of the ECG
    Just after the QRS correlates to what phase of PA waveform
  15. Pulmonary catheter lines
    • Single thin black line is 10cm
    • Single thick black line is 50cm
    • Double thick black line is 100cm
  16. PA catheter insertion sites
    • Right internal jugular
    • Left subclavian
    • Femoral veins
  17. PAC positions
    • RA--25-30 cm (proximal port/lumen)
    • RV--35-45 cm
    • PA--50-55 cm (distal port/lumen)
  18. Use of PAC
    • Assessment of volume status where CVP is unreliable
    • Sampling of mixed venous blood to calculate shunt fraction
    • Measurement of CO using thermodilation
    • Derivaion of other cardiavascular indices such as PVR, o2 delivery and uptake
  19. Complications of insertion
    • Valve rupture
    • Pulmonary embolism
    • Pulmonary infarct
    • Pulmonary artery rupture and hemorrhage
    • Dysrhythmias
    • Infection
    • Pneumothorax
    • Bleeding around site
    • Balloon rupture
    • Knotting of catheter in RV
  20. The PAWP should always be lower than
    The PAP should always be higher than
  21. Clues for determining RV waveform
    • Waves are taller in appearance than PAs
    • Waveform is symmetrical in shape with no dicrotic notch
    • Closer to the QRS than PAP
    • Inflation of the wedge ballon fails to dampen waveform
  22. RA systole wave
    a wave is the
  23. RA diastole wave
    x wave descent is
  24. Tricuspid valve closure wave
    c wave is
  25. RA filling/tricuspid valve closed wave
    v wave is
  26. RA emptying at opening of tricuspid valve/onset of right ventricle diastole
    y wave descent is
  27. Causes of decreased CVP/RAP (2-6 mmHG)
    • Hypovolemia
    • Vasodilation
    • Decreased venous return (preload)
    • Negative pressure ventilation
  28. Causes of increased CVP/RAP (2-6 mmHg)
    • Hypervolemia
    • Right-sided heart failure
    • Cardiac tamponade
    • Positive pressure ventilation
    • COPD
    • Pulmonary HTN
    • Pulmonary embolus
    • Pulmonic stenosis
    • Tricuspid stenosis
    • Tricuspid regurgitation
  29. Causes of increased RVP (15-25 / 0-5 mmHg)
    • Pulmonary HTN caused by left heart failure
    • COPD
    • Pulmonary embolus
  30. Causes of increased PAP (15-25 / 8-15 mmHg)
    • Fluid overload
    • Atrial or Ventricular defects
    • Pulmonary diseases
    • LV failure
    • Mitral stenosis
    • Mitral regurgitation
  31. Causes of decreased PAWP/PCWP (8-12 mmHg)
    • Hypovolemia
    • Venodilating drugs
  32. Causes of increased PAWP/PCWP (8-12 mmHg)
    • LV failure
    • Constrictive pericarditis
    • Mitral stenosis
    • Mitral regurgitation
    • Fluid overload
    • Renal failure
  33. Causes of increased PVR (50-250 dys)
    Pulmonary disease
  34. Causes of decreased SVR (800-2500 dys)
    • Septic shock
    • Anaphylactic shock
    • Neurogenic shock
    • Vasodilators
  35. Causes of increased SVR (800 -2500 mmHg)
    • Hypovolemic shock
    • Cardiogenic shock
    • RV MI
    • Aortic stenosis
    • Vasoconstrictors
  36. Rolling PAWP waveforms are indicative of
    Increased PAWP (pulmonary congestion) readings have a waveforms that is
  37. Phlebostatic axis is located at
    The junction of the vena cava and the right atrium is known as the
  38. Cather whip is noted by the waveform being
    Exaggerated wave form, caused by HTN, are known as
  39. Overdampened waveforms have a one line flush test and are caused by
    Kinked catheter tips, tip against a wall, increased pressure in the bag, will all lead to
  40. Underdampened waveforms show many lines of oscillation and are cause by
    Air in the system, loose connections, low pressure in the bag, and altitude changes all lead to
  41. Hypovolemic shock lab values present as (4 values)
    CVP low, CI low, PAWP low, SVR high
  42. Cardiogenic shock lab values present as (4 values)
    CVP high, CI low, PAWP high, SVR high
  43. RVMI lab values present as (4 values)
    CVP high, CI low, PAWP low, SVR high
  44. Septic shock lab values present as (3 values)
    CI low, HR normal or slow, SVR low
  45. Anaphylactic shock lab values present as (3 values)
    CI low, HR fast, SVR low
  46. Coronary Perfusion Pressure (CPP, 50-60 mmHg) formula is
    DBP-PAWP (50-60 mmHg)
  47. Mean Arterial Pressure (80-100 mmHg) formula is
  48. CVP/RAP reflects
    Right atrial pressure preload lab value is measured by
  49. PAP reflects
    Left and Right sided heart pressure lab value is measured by
  50. PAWP reflects
    Pressure on the left side of the heart, preload, is measured by
  51. CO formula is
    HR x SV
  52. CI definition is
    Based on BSA and is more accurate than CI, this assesses blood flow
  53. SV is
    Amount of blood ejected with each heartbeat from the ventricles during systole
  54. SI is
    Components of SV are preload, afterload, and contractility
  55. PVR is
    Measurement of afterload in right ventricle is
  56. SVR is
    measurement of afterload in left ventricle
  57. LAP reflects
    Filling pressure in left ventricle
  58. Drug of choice for distributive shock is
  59. Levophed, 2-12 ug/min, acts by
    increasing coronary blood flow with both alpha and beta effects
  60. Drugs that decrease preload (3)
    • NTG
    • Morphine
    • Lasix
  61. Drugs that increase preload (2)
    • Fluid
    • Vasoconstrictors
  62. Drugs that decrease afterload (5)
    • Nipride
    • Corlopram
    • Calcium channel blockers
    • Dobutrex
    • Xatecor
  63. Drugs that increase afterload (4)
    • Dopamine
    • Neosynephrine
    • Levophed
    • Epinephrine
  64. Isovolmetric contraction is defined as
    The period when all four valves are closed is called
  65. Spontaneous breathing causes a drop in vascular pressures
    Immediately before inspiration, and gradually rising until end expiration
  66. Hemodynamic pressure should be evaluated
    At the end of expiration, read
  67. The z point is used to measure atrial pressure and it is
    A line drawn from the end of the QRS to the hemodynamic tracing, and is delayed by .08-.12 second for PAWP
Card Set:
CCT-Hemodynamic Monitoring
2011-11-14 20:55:32
CCT Hemodynamic

CCT Hemodynamic Monitoring
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