–  L&R ventricles receive blood from atria

–  ventricles contract & push blood through aorta & pulmonary artery

–  volume left in ventricle at end of systole

–  60 - 70% of total end diastolic volume

=CO/BSA

~2.4 - 4 L/min

SV adjusted

crude indicator of contractility

=SV/BSA

~33-60 ml/beat

–  an estimate of arterial vascular tone

–  vasoconstriction/vasodilation = AFTERLOAD

–  800-1200 dynes/sec

–  estimates the outflow resistance of blood to the lungs

–  PVR = (PAP - CVP) x 80/CO

–  50-150 dynes/sec

invasive catheter and tubing

transducer

amplifier/recording

300mgHg pressure inflation cuff

3-way stopcocks

inline flush device

"zero"

phlebostatic axis

open transducer and flush system

calibrate every 8 hr or per P&P

Ind: comp. CO, tissue perfusion, or vol. status

Measures: Sys., Dias., MAP

Sites: Radial, dorsalis pedis, femoral artery, aux, brachial

** Allen Test

=(D*2 + S)/3

Range: 70-105

Necessary: 60 for perfusion

Central Venous Pressure Monitoring (CVP)

**CVP = R Atrial Pressure

Will also reflect RV End Dias. Press. (RVEDP)

Indications: fluid alterations

Measures: R Atrium

Trendelenberg, Must hold breath on insertion, Seldinger Technique.

CXR to ensure no hemo/pneumothorax

Sites: subclavian, inter. Jug. Femoral, antecubital fossae veins

Indications: dx and eval of heart disease, shock states, alterations in CO and fluid vol.

Measures: several Hemo parameters: PA S/D, PA MAP, PA WP, CO, LV fxn

Insertion: Seldinger Tech, 4-6 lumens, confirm placement w/ CXR

PA Lumens

1 proximal

2 Distal

3 Balloon

4 Thermistor

5 Infusion Ports

1 in RA, IV infusion, CVP measurement, W/D venous samples, injection of fluid for CO determination

2 records PA press., end top PA cath. and sit. in Pulm. Art.

3 measures PAWP, also assists in insertion to mim. RV ectopy

4 4cm from the tip, meas. temp and thermodilution of CO

5 med admin

monitor HR-rhythm, and BP

Change in waveforms

additional lumen for vol or drug infusions

continuous SvO2 with fiberoptic lumen

Art. and Vent. pacing electrodes

RV volumentric PR Catheter measures RV strock Vol

New continous Cardiac Output

Vent. Dysrhytmias

endocarditis

Valvular Damage

Cardiac Rupture

cardiac tamponade

Rupter PA

PA thrombosis

embolism

hemorrhage

infection

20-30 mmHg

-peak pressure attained as the RV ejects the SV

8-15 mmHg

-movement of blood from the PA out in the lung capillaries

8-12 mmHg

-relaiable indirect measure of LV fxn (LVEDP)

Pt position- supine, no more than 60degrees

Resp Varation- measure @ end of expiration

4-8 L/min

Equ: PA Cath w/ therm., injectate (low temp), CO computer

Procedure: 5-10mL bolus @ end of exhal, inject <4 sec (Supine to <60degrees HOB)

3 meas. w/in 10% mean averaged!!!!!

2.5-4 L/min/m

-good assessemtn of vent. pump performance

=CO/BSA

*computer auto calc BSA based on wt&ht

-indications: imbalance btwn Art. O2 (SaO2) and O2 demand @ tissule levl by sampling desat/mixed venous blood from the PA [SvO2=60-80%]

-4 factors ov O2 supply: CO, HgB, SaO2, tissue met. (vO2)

-SvO2 Sampling: distal PA port

-vO2: degree to which body tissues are consum. O2

-dO2: adequacy of the O2 delivered to the tissue levl

60-80 %

high: increase O2 delv. or decreased O2 consump.; high FiO2, hyperoxia, hypothermia, anestsia, hypothyroidism; calibration error

low: anemia, shock, dysrhythmias; MI, CHF, restrictive lung disease, cardiac tamponade

8-15 mmHg

high: LV failure, fluid status, cardiac tamponade mech. vent.; signals an incr. of LV blood vol. ejected during syst.

low: hypovolemia; reduction of LV blood vol. being ejected during syst.

20-30 mmHg

*peak press. attained as RV eject SV

8-12 mmHg

low: hypovol., dehydration, venous vasodilation, diuretics

High: AMI HF AS