1.Review indications for the use of PA catheter with heart failure patients. 2.The difference of the four major types of PA catheters. 3.Review the pressure data collected for the PA and catheter. 4.Review the risks of the use of the PA catheter. 5.Understand the general rules of handling an inserted PA catheter.
“There are no universally accepted indications for pulmonary artery catheterization because pulmonary artery catheters have not been shown to improve outcomes.” However, there are situations in which pulmonary artery catheterization may be helpful to manage and assess patients www.UpToDate.com
6 Invasive hemodynamic monitoring can be useful for carefully selected patients with acute HF who have persistent symptoms despite empiric adjustment of standard therapies, and a. whose fluid status, perfusion, or systemic or pulmonary vascular resistances are uncertain; b. whose systolic pressure remains low, pr is associated with symptoms, despite initial therapy; c. whose renal function is worsening with therapy; d. who require parenteral vasoactive agents; or e. who may need consideration for advanced device therapy or transplantation.
Diagnostic = Right Heart Cath -Differentiate cause of shock Cardiogenic/Hypovolemic /Septic -Differentiate mechanism of pulm edema Cardiogenic/noncardiogenic -Evaluate pulmonary hypertension
Therapy Heart Failure Complicated MI Cardiac Surgery Pharmacological therapy -Vasopressors, Inotropes, Vasodilators Nonpharmacological therapy -fluid management ie Ultrafiltration
R.BBB Tricuspid/pulmonic valve stenosis Artificial tricuspid/pulmonic valves Right Atrial/Ventricular mass New pacemaker Coagulopathy
Under-damping Excessive tubing or stopcocks systolic overshoot (the artificial exaggeration of systolic pressure) Caused by the patient: hypertension, atherosclerosis, vasoconstriction, aortic regurgitation, or hyperdynamic ie sepsis Over-damping Air bubbles, blood, kinked or non-pressure tubing Caused by the patient: aortic stenosis, vasodilatation, or low cardiac output state