Beruflich Dokumente
Kultur Dokumente
• Pain
• Petechiae and ecchymoses
• Limb edema
• Venous stasis and thrombophlebitis
• Peripheral neuropathy
• Compartment syndrome
IBP/ Direct blood pressure monitoring
• Despite various complications and need of expertise IBP monitoring is ideal
reference standard for BP monitoring ,which provide timely and crucial
information.
• Arterial cannulation can be done in radial, ulnar, brachial, axillary or femoral artery.
• More central the artery is more are the chances of embolism. Axillary and femoral
arterial cannulation results waveforms that resembles change in pressure in aortic
arch more closely.
• In radial artery cannulation hyperextension is avoided to prevent median nerve
injury and in femoral artery cannulation must be done below the inguinal ligament.
MODIFIED ALLENS TEST
Although their routine use is not common, they are still occasionally placed
for management of critically ill patients
Physiological Measurements
• Direct measurements of the following can be obtained from an accurately placed
pulmonary artery catheter(PAC)
• Correct placement :
• By either pressure waveform/ fluoroscopic guidance
• Rapid flush test:
Catheter waveforms and pressures
When catheter tip is across tricuspid valve pressure waveform changes and systolic
pressure increases
• 2 pressures are typically measured in right ventricular pressure waveform
• Peak RV systolic pressure 15-25mmHg
• Peak RV diastolic pressure 3-12 mmHg
• As a general rule elevations in RV pressure:
• Diseases increasing pulmonary artery pressure
• Pulmonic valve disorders
• Diseases affecting right ventricle
• Pulmonary vascular and pulmonary valve disorders a/w increased RV systolic pressures
• When catheter tip passes pulmonary valve Diastolic pressure increases and
characteristic dichrotic notch appears in waveform
• Normal pulmonary artery pressures:
• Systolic 15-25mmHg
• Diastolic 8-15 mmHg
• Mean 16 (10-22mmHg)
• Acute on Chronic:
• Hypoxemia induced pulm VC in patient with chronic cardiopulmonary disease
• Chronic:
• Pulmonary hypertension
• Types of PHT:
• Primary
• Due to Heart Disease
• Due to Lung Disease
• Due to chronic venous thromboembolism
• Miscellaneous ( Sickle Cell Anemia)
Pulmonary arterial occlusion pressure
• Once catheter tip has reached PA, it should be advanced until PAOP is
identified by decrease in pressure and change in waveform
• Best measured in
• Supine position
• At end of expiration
• Zone 3 (most dependent region)
• Abnormal waveforms
• Large a waves:
• MS
• LV systolic /diastolic function
• LV volume overload
• MI
• Large v waves - MR
• Calculation of cardiac output:
• 2 methods
• Thermodilution method
• Fick’s Method
• Systolic HF
• Systemic A-V fistulas
• Diastolic HF
• Anemia
• MR
• Beriberi
• Hypovolemia
• Renal Disease
• Pulmonary HT
• RVF • Sepsis
• Other uses of pulmonary artery catheter:
• Detection of Left to right shunts
• Estimation of systemic and pulmonary vascular resistance
Complications
• General:
• Immediate:
• Bleeding
• Arterial Puncture
• Air embolism
• Thoracic duct injury ( L side)
• Pneumothorax/hemothorax
• Delayed:
• Infections
• Thrombosis
• Related to insertion of PAC:
• Arrhythmias (most common- Ventricular/ RBBB)
• Misplacement
• Knotting
• Myocardial/valve/vessel rupture
AORTIC VALVE
MITRAL VALVE
CARDIOMYOPATHY
PACEMAKER WIRE
STRESS ECHOCARDIOGRAPHY