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
Normal Pressures - 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
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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
Canon a-waves
Large v-waves
Over - Wedging |
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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
R=(Pin – Pout)/Q Hydraulic Analogy to Ohm’s Law (R=∆V/I)
SVR = (MAP – CVP)/CO NL 700-1600 dynes*sec/cm5
Marco Perez 1/04
CARDIOVASCULAR CATHETERIZATION FACILITY PROCEDURE LOG PATIENT NAMEID DOB
CATHETERISE A FEMALE PATIENT (BREAKDOWN OF THE SKILL) STUDENT
CEPHALIC AND SAPHENOUS CATHETERIZATION ANY OF THE CATHETERS THAT
Tags: basics indications, catheter, cardiogenic, indications, basics