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37 Cards in this Set

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What is a Swan Ganz Catheter and what does it measure
A Swan Ganz Catheter is used in Pulmonary Artery Catheterization, and its purpose is diagnostic.Allows for direct, simultaneous measurement of pressures in the right atrium and ventricle, the pulmonary artery, and the wedge pressure (preload of left ventricle).
catheter with an inflatable balloon at its tip, which can be inserted into the pulmonary artery via the right chambers of the heart. Inflation of the balloon enables indirect measurement of pressure in the left atrium.
what is hemodynamic monitoring?
measurement of pressure, flow, and oxygenation of blood within the cardiovascular system
Steps to insert a Swan Ganz Catheter.
Same as inserting the CVC, but also:
1. calibrate before insertion
2. flush all lumens prior to insertion
3. assist the physician with floating the Swan Ganz (inserted with the balloon down, balloon up in right atrium, then begin to monitor waveforms and HR)
How does hemodynamic monitoring work?
a tranducer is hooked into the patient through an IV line (central or arterial), and pressure tubing that hooks into an external machine.
What is a central venous catheter and what does it measure?
Central venous access is the placement of a venous catheter in a vein that leads directly to the heart (aka the neck, chest, or groin).

It measures the CVP.
It is also used as venous access when there are no other options, administration of drugs that cannot be given peripherally (inotropes, vasoactives), adminstration of hypertonic solutions such as TPN, hemodialysis and plasmaphoresis
What are the indications for hemodynamic monitoring?
SHEMS-G
Shock
Heart Failure
Evaluate Pharmacological Treatments
Myocardial Infarctoin
Surgery
Guide for therapy- fluid vs. diuretics
What are indications for arterial monitoring?
1. continuous blood pressure monitoring
2. frequent blood sampling
What types of tubing are used?
Triple Lumen Catheter, Swan Ganz Catheter, Arterial Lines
How to place an arterial catheter.
Preferred location is radial due to collateral circulation (other sites include brachial, femoral, and dorsalis pedis)
Perform an Allen's Test- assess the patency of the radial-ulnar arch.
DO NOT PUNCTURE if color return is over 7 seconds.
Continue to perform neurovascular checks distal to the arterial line.
What does Central Venous Pressure measure and what is a normal reading?
Preload of the right ventricle. thats why it is also known as Right Atrial Pressure (RAP)
4-8mmHg
What kind of tubing does the CVP get its measurement from?
The distal port of the triple lumen catheter, or the blue port of the Swan Ganz catheter
What would cause a low CVP?
hypovolemia
What would cause a high CVP?
fluid overload, left ventricular failure
What does the Left Atrial Pressure (Wedge Pressure) measure and what is a normal reading?
left ventricular preload (when the balloon is inflated)
6-12mmHg
What type of tubing and what port do you use to measure the LAP(wedge) pressure?
the distal portion of the Swan Ganz catheter (when the balloon is inflated)
What causes a high LAP reading?
fluid overload, ventricular failure
What causes a low LAP reading?
hypovolemia
What are complications from a LAP?
1. ischemia to the pulmonary artery, which can lead to necrosis (if the balloon is too inflated for too long)
2. pulmonary artery rupture from over inflation of the balloon (pt will bleed to death quickly)
What is Cardiac Output, the formula, and what is a normal reading?
HR x Stroke Volume = CO
it is the amount of blood ejected from the heart in one minute.
4-8L/min
How is the equipment used to get a CO reading? (2 ways)
it is measured by the Swan Ganz catheter two ways:
1. manual thermodilution where the RN will administer 10cc of cold NSS and see the reading. Do this several times and take an average
2. Continuous cardiac output monitoring which is done via machine
What causes a low CO? (6)
hypovolemia, HF, tachycardia, low contractility, cardiomyopathy, cardiogenic shock
What causes a high CO?
higher preload, fluid overload, medication therapy (positive inotropes, digoxin)
What is the cardiac index, and what is the normal range? (how do you calculate it)
The cardiac index is cardiac output according to body surface area (BSA). it is calculated as CO/BSA, and the normal range is 2.5-4.0L/min/m2.
*figure out the pts BSA using a height/weight chart
What measures the systemic vascular resistance (SVR) and how do you find it?
left ventricular afterload. it is calculated as ((MAP - CVP) x 80)/CO

-it is the pressure that the heart must squeeze AGAINST to get all of its blood out
What causes a high SVR?
vasoconstriction
What causes a low SVR?
vasodilation
What does the Mixed Venous Oxygen Saturdation (SVO2) measure, and what is a normal reading?
It reflects oxygenation at the tissue level.
Normal = 60-80
How is the SVO2 measured?
It is measured using fiber optics with special Swan Ganz or Triple Lumen Catheters.
What causes a low SVO2?
sepsis, increased BMR
What causes a high SVO2?
tissues aren't pulling the O2 off, which can result from too many blood transfusions. Or they could be receiving too much supplemental O2. Check how many liters are being given.
How does SVO2 guide nursing care?
Think critically here. Know what causes a high and low SVO2, and know how to fix those.
High- check how many liters they are geting, or think: why are the tissues using less oxygen?
Low: why could the tissues be needing more oxygen than normal?
Complications of inserting a central line?
Immediate vs. delayed

1. pneumothoraces can occur if the catheter goes in to far. can be spontaneous, or slight and symptoms creep up slowly. the
first sign is Tachypnea!!
2. Infection- duh
3. air embolism- rare
4. Hemorrhage- more common in the jugular vein
5. Arryhthmia- may occur when the wire comes into contact with the endocardium, but is resolved when the wire is pulled back
Which port do you NEVER infuse through?
The PA port
What is a transducer?
converts physiological events into electrical signals. to zero, turn the stop cock upward and remove the cap to atmospheric air
What do you need to know to perform hemodynamic calibration?
how to calibrate the system.
-use the phlebostatic axis for reference to obtain proper placement.
-every position change the patient has, the machine needs to be recalibrated!
What is the phlebostatic axis?
the level of the right atrium, which lies at the fourth intercostal space in the midaxillary line. The patient lies supine, with the head between 0 and 45 degrees.
What are complications from an arterial catheter?
Thrombosis or arterial inclusion, and infection