Invasive hemodynamic monitoring using a pulmonary artery catheter can help guide treatment for complex patients by providing detailed cardiac information. While use of these catheters is declining somewhat, the data they provide on issues like cardiogenic shock and pulmonary pressures can still be useful for diagnosis and management. For a complex patient, this information could be used to individualize a treatment plan involving medications, devices, or other therapies. However, there are also risks to consider from potential complications of catheter insertion or use.

1. [From 10$/Pg] Ci Values Also Help
[From 10$/Pg] Ci Values Also HelpAmelia MangunePosted DateApr 14, 2022, 1:37
PM(edited)UnreadExplain the value of invasive hemodynamic monitoring, including a
discussion of whether an acute, chronic, or complex-care patient is a candidate for this type
of assessment. For a complex-care patient, propose an evidence-based treatment plan
regarding the hemodynamic information. What are the risk factors to take into
consideration for this patient?Clinical decision-making about optimizing treatments for
complex-care patients can be guided effectively by hemodynamic monitoring with a
pulmonary artery catheter (PAC, also known as Swan-Ganz or right heart catheter) (Saxena
et al., 2020). Based on Ingbar & Thiele (2018), pulmonary artery catheter (PAC) use in
hemodynamic monitoring is declining because clinical trials have shown no mortality
advantage. However, hemodynamic data furnished by a PAC can confirm the presence and
severity of cardiogenic shock (CS), involvement of the right ventricle, left-to-right shunting,
pulmonary artery pressures and trans-pulmonary gradient, and the pulmonary and
systemic vascular resistance. It can support recognizing acute mitral regurgitation (MR),
decreased left atrial filling pressure, and secondary occult sepsis and exclude left-to-right
shunts. Equalization of diastolic pressures indicates cardiac tamponade, but an
echocardiogram is more definitive. The detailed hemodynamic profile can be utilized to
individualize and monitor therapy and provide prognostic details, such as cardiac index and
cardiac force. The AHA currently recommends using a PAC for potential utilization in
diagnostic or CS management uncertainty cases or patients with severe CS who are
unresponsive to initial therapy. Therapeutic options for patients in CS include inotropes and
vasopressors and mechanical circulatory support (MCS) devices that pump blood from 1
vascular chamber to another to improve systemic hemodynamics. Winehouse (2021) wrote
that common PAC insertion complications include atrial and/or ventricular arrhythmias.
Less commonly, catheter misplacement or knotting can happen. Perforation of a cardiac
chamber and rupture of a cardiac valve or the pulmonary artery are rare complications that
can be fatal. Complications of catheter use include pulmonary artery rupture, pulmonary
infarction, thromboembolic events, infection, and data misinterpretation. In addition, the
benefit must be balanced against risks, as with any invasive diagnostic tool. Absolute
contraindications to PAC placement include infection at the insertion site, right ventricular
assist device, insertion during cardiopulmonary bypass, and lack of consent. Relative
contraindications include the presence of a coagulopathy (INR >1.5), thrombocytopenia
(platelet count <50,000/microL), electrolyte disturbances (hypo/hyper -kalemia, -

2. magnesemia, -natremia, -calcemia), and severe acid-base disturbances (e.g., pH <7.2 or
>7.5). Normal values and differential diagnoses for the alteration in normal readings for
cardiac index. According to Patel, Durland & Makaryus (2021), the cardiac index (CI)
assesses the cardiac output value based on the patient’s size. To calculate CI, divide the
cardiac output by the person’s body surface area (BSA). The normal range for CI is 2.5 to 4
L/min/m2. Cardiac output (CO) can be broken down as the product of stroke volume (SV-
blood volume ejected by one heartbeat) and heart rate (HR). Notably, this measures left
ventricular output and is a significant clinical indicator of left ventricular function.
Therefore, conditions that affect HR or SV directly impact cardiac output. Both cardiac
output and cardiac index are essential to understand if a patient’s heart pumps enough
blood and delivers enough oxygen to cells. CO and CI values also help manage specific drug
treatments, such as inotropics and vasopressors. Also, CI is a hemodynamic measurement
used to help evaluate the different forms of shock (cardiogenic, obstructive, hypovolemic,
and distributive). CO= stroke volume X heart rateCI= cardiac output/ body surface
areaDifferential diagnoses of an abnormal cardiac index reading include myocardial
ischemia, pulmonary disease (such as COPD), and patients with sleep apnea, anxiety, and
depression. In addition, patients presenting with fluid retention may complain of a leg or
abdominal swelling. Other causes of edema include venous thrombosis or insufficiency,
renal sodium retention, drug side effect (e.g., CCB), and cirrhosis (Colucci & Borlaug,
2021).ReferencesColucci, W.S. & Borlaug, B.A. (March 04, 2021). Heart failure: Clinical
manifestations and diagnosis in adults. UpToDate.
https://www.uptodate.com/contents/heart-failure-clinical-manifestations-and-diagnosis-
in-adults#H305292239Ingbar, D.H. & Thielee, H. (2018). Cardiogenic shock and pulmonary
edema. In Jameson, J.L., Kasper, D.L., Longo, D.L., Fauci, A.S., Hauser, S.L. & Loscalzo, J.
(Eds). Harrison’s Principles of Internal Medicine (20th Ed, Vol.2, Part 1, Chap.298, pp.448).
McGraw-Hill Education. Patel, N., Durland, J. & Makaryus, A.N. (September 28, 2021).
Physiology, Cardiac index. https://www.ncbi.nlm.nih.gov/books/NBK539905/Saxena, A.,
Garan, A.R., Kapur, N.K., O’Neill, W.W., Lindenfeeeld, A., Pinney, S.P., Uriel, N., Burkoff, D. &
Kern,M. (April 6, 2020). Value of hemodynamic monitoring in patients with cardiogenic
shock undergoing mechanical circulatory support.
https://doi.org/10.1161/CIRCULATIONAHA.119.043080/ Circulation;141:1184–
1197Weinhouse, G.L. (June 24, 2021). Pulmonary artery catheterization: Indications,
contraindications, and complications in adults. UpToDate.
https://www.uptodate.com/contents/pulmonary-artery-catheterization-indications-
contraindications-and-complications-in-
adults?search=pulmonary%20artery%20catheter&source=search_result&selectedTitle=1~
150&usage_type=default&display_rank=1#H13