Pulmonary Artery Catheterization Overview and Management
Indications—7 ...

Pulmonary Artery Catheterization Overview and Management

Indications—7 primary indications for the placement of PA lines:

(1) diagnose etiology of shock (e.g., cardiogenic vs. distributive) (2) diagnose cardiogenic vs. non-cardiogenic pulm. edema (3) diagnose PH (4) diagnose L->R shunting (5) diagnose valve disease (6) diagnose pericardial disease (7) tailored therapy

Venous Waveforms (CVP/PCWP):

 • a wave: atrial contraction; coincides with QRS complex (on CVP tracing)

 • c wave: bowing of TV/MV into atrium during ventricular contraction; more visible in 1st degree AV block. Often absent on PCWP.

 • x descent: atrial relaxation (early x descent), downward mvmt. of TV/MV (late x descent)

 • v wave: passive atrial filling (venous return) when TV/MV closed; coincides with T wave

 • y descent: rapid atrial emptying following opening of the TV/MV (ventricular diastole)

Calculating Hemodynamic Parameters:

 • Normal: “rule of 5s”->RA 5, RV 25/5, PA 25/10, PCWP 10, LV 125/10

 • Cardiac Output:

     o Fick = VO2 / (13.4 * Hgb * [SpO2 – MvO2]) [nl: 4-7 L/min]

                   VO2 ≈ 250 ml/min OR 3*wt(kg) OR 125*BSA

     o Thermodilution: Temperature change (measured by thermistor in PA) is proportional to LV CO (inaccurate w/ TR, intracardiac shunt)

 • Cardiac index = CO/BSA [normal: 2.6-4.2 L/min/m2]

 • SVR = (MAP-CVP) / CO x 80 [normal: 700-1200 dynes*s*cm5]

 • PVR = (mPAP-PCWP) / CO x 80 [normal: 20-130 dynes*s*cm5]

Hemodynamic Considerations

Clinical Considerations

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