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Lab Value for CVP
2-6 mmHg
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Lab Value for RAP
2-6 mmHg
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Lab Value for RVP
15-25 / 0-5 mmHg
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Lab Value for PAP
15-25 / 8-15 mmHg
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Lab Value for PAWP
8-12 mmHg
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Lab Value for PCWP
8-12 mmHg
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Lab Value for CO
408 L/min
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Lab Value for CI
2.5-4.2 L/min
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Lab Value for SV
60-135 mL
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Lab Value for SI
25-45 Ml/m2
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Lab Value for PVR
50-250 dyn
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Lab Value for SVR
800-1200 dyn
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Lab Value for LAP
4-12 mmHg
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PAS correlates to what part of the ECG
Just after the QRS correlates to what phase of PA waveform
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Pulmonary catheter lines
- Single thin black line is 10cm
- Single thick black line is 50cm
- Double thick black line is 100cm
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PA catheter insertion sites
- Right internal jugular
- Left subclavian
- Femoral veins
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PAC positions
- RA--25-30 cm (proximal port/lumen)
- RV--35-45 cm
- PA--50-55 cm (distal port/lumen)
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Use of PAC
- Assessment of volume status where CVP is unreliable
- Sampling of mixed venous blood to calculate shunt fraction
- Measurement of CO using thermodilation
- Derivaion of other cardiavascular indices such as PVR, o2 delivery and uptake
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Complications of insertion
- Valve rupture
- Pulmonary embolism
- Pulmonary infarct
- Pulmonary artery rupture and hemorrhage
- Dysrhythmias
- Infection
- Pneumothorax
- Bleeding around site
- Balloon rupture
- Knotting of catheter in RV
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The PAWP should always be lower than
The PAP should always be higher than
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Clues for determining RV waveform
- Waves are taller in appearance than PAs
- Waveform is symmetrical in shape with no dicrotic notch
- Closer to the QRS than PAP
- Inflation of the wedge ballon fails to dampen waveform
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RA systole wave
a wave is the
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RA diastole wave
x wave descent is
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Tricuspid valve closure wave
c wave is
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RA filling/tricuspid valve closed wave
v wave is
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RA emptying at opening of tricuspid valve/onset of right ventricle diastole
y wave descent is
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Causes of decreased CVP/RAP (2-6 mmHG)
- Hypovolemia
- Vasodilation
- Decreased venous return (preload)
- Negative pressure ventilation
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Causes of increased CVP/RAP (2-6 mmHg)
- Hypervolemia
- Right-sided heart failure
- Cardiac tamponade
- Positive pressure ventilation
- COPD
- Pulmonary HTN
- Pulmonary embolus
- Pulmonic stenosis
- Tricuspid stenosis
- Tricuspid regurgitation
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Causes of increased RVP (15-25 / 0-5 mmHg)
- Pulmonary HTN caused by left heart failure
- COPD
- Pulmonary embolus
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Causes of increased PAP (15-25 / 8-15 mmHg)
- Fluid overload
- Atrial or Ventricular defects
- Pulmonary diseases
- LV failure
- Mitral stenosis
- Mitral regurgitation
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Causes of decreased PAWP/PCWP (8-12 mmHg)
- Hypovolemia
- Venodilating drugs
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Causes of increased PAWP/PCWP (8-12 mmHg)
- LV failure
- Constrictive pericarditis
- Mitral stenosis
- Mitral regurgitation
- Fluid overload
- Renal failure
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Causes of increased PVR (50-250 dys)
Pulmonary disease
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Causes of decreased SVR (800-2500 dys)
- Septic shock
- Anaphylactic shock
- Neurogenic shock
- Vasodilators
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Causes of increased SVR (800 -2500 mmHg)
- Hypovolemic shock
- Cardiogenic shock
- RV MI
- Aortic stenosis
- Vasoconstrictors
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Rolling PAWP waveforms are indicative of
Increased PAWP (pulmonary congestion) readings have a waveforms that is
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Phlebostatic axis is located at
The junction of the vena cava and the right atrium is known as the
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Cather whip is noted by the waveform being
Exaggerated wave form, caused by HTN, are known as
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Overdampened waveforms have a one line flush test and are caused by
Kinked catheter tips, tip against a wall, increased pressure in the bag, will all lead to
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Underdampened waveforms show many lines of oscillation and are cause by
Air in the system, loose connections, low pressure in the bag, and altitude changes all lead to
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Hypovolemic shock lab values present as (4 values)
CVP low, CI low, PAWP low, SVR high
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Cardiogenic shock lab values present as (4 values)
CVP high, CI low, PAWP high, SVR high
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RVMI lab values present as (4 values)
CVP high, CI low, PAWP low, SVR high
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Septic shock lab values present as (3 values)
CI low, HR normal or slow, SVR low
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Anaphylactic shock lab values present as (3 values)
CI low, HR fast, SVR low
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Coronary Perfusion Pressure (CPP, 50-60 mmHg) formula is
DBP-PAWP (50-60 mmHg)
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Mean Arterial Pressure (80-100 mmHg) formula is
(2xDBP+SBP)/3
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CVP/RAP reflects
Right atrial pressure preload lab value is measured by
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PAP reflects
Left and Right sided heart pressure lab value is measured by
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PAWP reflects
Pressure on the left side of the heart, preload, is measured by
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CI definition is
Based on BSA and is more accurate than CI, this assesses blood flow
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SV is
Amount of blood ejected with each heartbeat from the ventricles during systole
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SI is
Components of SV are preload, afterload, and contractility
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PVR is
Measurement of afterload in right ventricle is
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SVR is
measurement of afterload in left ventricle
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LAP reflects
Filling pressure in left ventricle
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Drug of choice for distributive shock is
Levophed
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Levophed, 2-12 ug/min, acts by
increasing coronary blood flow with both alpha and beta effects
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Drugs that decrease preload (3)
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Drugs that increase preload (2)
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Drugs that decrease afterload (5)
- Nipride
- Corlopram
- Calcium channel blockers
- Dobutrex
- Xatecor
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Drugs that increase afterload (4)
- Dopamine
- Neosynephrine
- Levophed
- Epinephrine
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Isovolmetric contraction is defined as
The period when all four valves are closed is called
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Spontaneous breathing causes a drop in vascular pressures
Immediately before inspiration, and gradually rising until end expiration
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Hemodynamic pressure should be evaluated
At the end of expiration, read
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The z point is used to measure atrial pressure and it is
A line drawn from the end of the QRS to the hemodynamic tracing, and is delayed by .08-.12 second for PAWP
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