What part of the pulmonary artery catheter: Measure pulmonary artery pressures, Aspirate mixed venous samples, Inject medications, Continuous monitoring of SvO2
What is the max inflation vol. of the balloon and the swanz?
What part of the pulmonary artery catheter: Temperature sensing device, Used during thermodilution QT measurements, Measures core temperature
This is the most common technique: A bolus of solution of known volume and temp. is injected into the R. atrium, and the resultant change in blood temp. is detected by a thermistor previously placed in the pulmonary artery w/ a catheter. The degree of temp. change between the prox. port and distal tis is a function of this.
Measuring the QT w/ thermaldilution
The normal cardic output curve looks like?
a rapid smooth upstroke and a gradula downstroke.
The small area under the cardiac curve indicates?
a high cardiac output.
A large area under the cardiac curve indicates?
a low cardiac output
Cardiac output is ________ proportional to the area ubder the cardiac curve.
lies in the right ventricle. Measure CVP. Inject medications. Aspirate blood samples. Inject thermal bolus for thermal dilution CO measurements
What are some indications for pulmonary artery catheter.
Hemodynamically unstable patients, Complex-acute heart disease, Acute-severe pulmonary disease, Shock of all types if severe or prolonged, Severe multisystem trauma or large-area burn injury, Major systems dysfunction undergoing extensive operative procedures
What are some common uses for a pulmonary artery catheter?
What are some things that would casue the pulmonary vascular resistance to increase?
Constriction, obstruction, and compression
is also referred to as: Pulmonary artery occlusion pressure (PAOP), Pulmonary artery wedge pressure (PAWP), Left atrial pressure, Left side preload, Left ventricular end-diastolic pressure, Left ventricular filling pressure
What can be used to estimate PCWP is some situations
A comparison of PCWP and PAP can be used to differentiate between
cardiac and non-cardiac pulmonary edema. Increased PCWP and PAP = cardiac. Normal PCWP and Increased PAP = Non-cardiac
What Causes Pulmonary Capillary Wedge Pressure to Decrease?
Right heart failure, Cor pulmonale, Pulmonary embolism, Pulmonary hypertension, Air embolism, Hypovolemia
What Causes Pulmonary Capillary Wedge Pressure to Increase?
left heart failure, mitral valve stenosis, CHF/ pulmonary edema, high PEEP effects, hypervolemia
What are the two common uses of the arterial catheter?
Measureing systemic artery pressure and collect ABG samples
Where the inserion site of the arterial catheter?
Radial (can be placed brachial, femoral, dorsalis pedis, umbilical neonates)
Add picture 38 and 39
should have done it by now
Sytolic (contraction) range
Diastolic (relaxation) range
normal Mean arterial pressure range
Causes of Decreased Arterial Pressure
Absolute and relative hyovolemia and cardiac failure. Improvement in circulatory volume and function, Sympathetic stimulation, Vasoconstriction, Administration of vasopressors
What is absolute hypovolemia?
blood loss and dehydration
What is relative hypovolemia?
shock and vasodilation
is the product of stroke volume and vascular resistance. Therefore, changes in either parameter can affect it.
is the difference between arterial systolic and diastolic pressure.
Pulse pressure (pulse = syst - dias)
This is an early sign of hypovolemia, decreased stroke volume(hypovoemia), increased blood vessel compliance(shock), and tachycardia all cause this.
Decreased Pulse pressure
This is an early sign of vol. restoration. Increased stroke vol.(hypervolemia), decreased vessel compliance(arteriosclerosis), and bradycardia all cause this
Increased pulse pressure
How do you calculate cardiac output?
QT= HRXSV or QT= (130XBSA)/[C(a-v)O2X10] or QT = VO2/[c(a-v)O2 X10]
What is the noral QT?
THis is used to normalize QT measurement among Pt's of varying body size.
Cardiac Index (CI)
What is the formula for CI?
what is the normal CI
CI valuse between 1.8- and 2.5 L/min/m^2 indicate?
CI< 1.8 L/min/m^2 may indicative of?
This is a measurment of the average QT per one heartbeat.
Strove Volume (SV) = QT/HR
What is the normal SV?
Used to normalize stroke volume measurements among patients of varying body size.
Stroke Volume Index (SVI)
33 � 47 mL/m2 (SV/BSA)
Digoxin (Lanoxin), Dobutamine (Dobutrex), Epinephrine (Adrenalin), Dopamine (Intropin), Isoproterenol (Isuprel), Digitalis, Amrinone (Inocor) are what kind of drugs and what do they do to contractility?
Positive Inotropic Drugs (? contractility)
Septic shock (early stages), Hyperthermia, Hypervolemia, ? vascular resistance can do what to contractility?
Propanolol (Inderal), Metoprolol (Lopressor), Atenolol (Tenormin) are what kind of drugs and what do they do to contractility?
Negative inotropic drugs and decrease contractility.
Septic shock (late stages), CHF, Hypovolemia, Pulmonary emboli, ? vascular resistance, MI can do what to contractility?
what will happen if Transducer or catheter higher than site?
fales low pressure reading
What will happen if Transducer or catheter lower than site?
false high pressure reading
What are 3 complications of arterial catheters?
Ischemia, hemorrhage, and infection
is pressure of the blood in the Vena cava, Right atrium, and Right ventricle. It is also referred to as Right atrial pressure (RAP), right side preload, and Right ventricular end-diastolic pressure
Central Venous Catheter (CVP)
measures right heart function and fluid levels
what is the normal CVP by TRANSDUCER?
0-8 (<8 mmHg)
What is the normal CVP by MANOMETER?
What are the three uses of a CVP?
Assement of R ventric. func. & intravasculad vol. status. Admin. of fluids, nutrition, blood, or drugs. Emergency route for pacemaker insertion.
Common indications of CVP?
Measure central venous pressure, Administer fluid, blood, or medications, Aspiration of blood samples
Where is the insertion site of CVP?
subclavian or internal jugular vein
Where is the CVP located?
superior vena cava near right atrium or withing right atrium
Decreased venous return (VOLUME!) Absolute hypovolemia, Blood loss - Hemorrhage, Dehydration) or Relative hypovolemia (Shock, Vasodilation) have what effect on CVP?
What can increase CVP?
Increased Venous retiurn, hypervolemia, increased intrathoracic pressure, Right heart failure, increased pulmonary vascular resistance, and compression around the heart
CVP is ideally read at the end of expiration because?
Spontaneous insp. causes CVP to fall and mechanical vent. causes CVP to rise
What are three complications for CVP?
infection, bleeding, and pneimothorax( greatest hazard)
When the monitor does not show a sharp waveform, no dicrotic notch. can be caused by Catheter can be obstructed or kinked.
Is an Inadequate tissue perfusion resulting in a hypoxic insult and causing widespread abnormal cell metabolism and membrane dysfunction.
A decrease in the effective circulating blood volume. cause by hemorrhage or non-hemorrhage ( dehydration and third space fluid space)
Is Systemic hypoperfusion due to profound heart failure and/or the ability to meet metabolic needs. End stage of heart disease caused by: MI, Myocarditis, Cardiac tamponade, and Severe valve dysfunction
Shock associated with any infectious disease which causes relative hypovolemia. Caused by many infectious agents, Predisposing factors, Invasive procedures, Organ damage, and Immunocompromised
A severe illness caused by over whelming infection of the bloodstream by toxin-producing bacteria.
Dysfunction of the sympathetic nervous system resulting in massive peripheral vasodilation and systemic hypoperfusion. Etiology: Brain or spinal cord trauma, Spinal anesthesia, and Drugs
Systemic reaction causing circulatory failure and biochemical abnormalities. Etiology: Drugs, Blood products, Foods, Pollens, and Venoms