The "fast flush" test - Following catheter placement, the dynamic response of the monitoring system to pressure should be assessed. (See "Pulmonary artery catheters: Insertion technique in adults", section on 'Insertion of the pulmonary artery catheter'.) Detailed discussion of correct PAC placement is provided separately. When the correct position has been confirmed, the arterial waveform and the right atrial pressure waveforms are simultaneously recorded with the pulmonary artery pressure (balloon deflated) or pulmonary artery wedge pressure waveforms (balloon inflated). Transesophageal echo has also been used to facilitate placement of the PAC. (See "Pulmonary artery catheters: Insertion technique in adults", section on 'Zeroing and referencing'.)Ĭorrect placement - Once the PAC has been zeroed and referenced, it is positioned using either pressure waveform or fluoroscopic guidance. Importantly, zeroing and referencing should be done prior to placement and repeated when time has elapsed between one set of measurements and another, especially if the patient’s position has been moved. Occasionally, in patients who cannot lie flat, zeroing and referencing are performed in the semi-recumbent position at approximately 30 degrees. Zeroing and referencing are generally performed with the patient lying in the supine position. Zeroing and referencing - The PAC must be appropriately zeroed and referenced to obtain accurate readings. These steps include zeroing, referencing, ensuring the catheter is in the correct position, and assessing the dynamic response using the “fast-flush” test. Oxygen uptake (VO 2 = CI x 13.4 x hemoglobin concentration x )ĮNSURING ACCURATE MEASUREMENTS - Certain steps must be performed before a pulmonary artery catheter (PAC) is used to measure hemodynamic variables.Oxygen delivery (DO 2 = CI x 13.4 x hemoglobin concentration x arterial oxygen saturation).Right ventricular stroke work index (RVSWI = x SVI x 0.136).Left ventricular stroke work index (LVSWI = x SVI x 0.136).Stroke volume index (SVI = CI/heart rate).Cardiac index (CI = CO/body surface area).Pulmonary vascular resistance (PVR = 80 x /CO).Systemic vascular resistance (SVR = 80 x /CO).The PAC can also indirectly measure the following: Mixed venous oxyhemoglobin saturation (SvO 2).Pulmonary artery occlusion pressure (PAOP pulmonary capillary wedge pressure pulmonary artery wedge pressure ).Right-sided intracardiac pressures (right atrium, right ventricle).PHYSIOLOGIC MEASUREMENTS - Direct measurements of the following can be obtained from an accurately placed pulmonary artery catheter (PAC): (See "Pulmonary artery catheters: Insertion technique in adults" and "Pulmonary artery catheterization: Indications, contraindications, and complications in adults".) The insertion technique, indications, contraindications, and complications of PACs are discussed separately. The interpretation of hemodynamic values and pressure tracings derived from the PAC is described in this topic. Interpreting hemodynamic data from PACs is important for the diagnosis and management of a range of conditions including shock and pulmonary artery hypertension ( table 1). INTRODUCTION - The pulmonary artery catheter (PAC Swan-Ganz or right heart catheter) can be used for a variety of clinical purposes.
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