Pulmonary artery catheterization
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Pulmonary artery catheter
Pulmonary artery catheter- indications ,contraindications, technique, interpretation of hemodynamic parameters and waveforms, complications
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The document discusses the pulmonary artery catheter, including its indications, contraindications, preparation, technique, interpretation of physiological values and waveforms, and complications. The pulmonary artery catheter can be used diagnostically to differentiate causes of shock, types of pulmonary edema, and detect intracardiac shunts. It can also be used therapeutically to help manage high-risk surgery patients, sepsis, heart failure, and guide pharmacologic therapy. Placement involves inserting the catheter into the internal jugular or subclavian vein and advancing it into the pulmonary artery using pressure readings and waveforms as guides. Measurements obtained include pressures, cardiac output, oxygen saturation, and derived values like vascular resistances. Complications include bleeding, arr
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The document discusses the pulmonary artery catheter, including its indications, contraindications, preparation, technique, interpretation of physiological values and waveforms, and complications. The pulmonary artery catheter can be used diagnostically to differentiate causes of shock, types of pulmonary edema, and detect intracardiac shunts. It can also be used therapeutically to help manage high-risk surgery patients, sepsis, heart failure, and guide pharmacologic therapy. Placement involves inserting the catheter into the internal jugular or subclavian vein and advancing it into the pulmonary artery using pressure readings and waveforms as guides. Measurements obtained include pressures, cardiac output, oxygen saturation, and derived values like vascular resistances. Complications include bleeding, arr
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This document provides information on central venous catheterization, including indications, contraindications, complications, techniques, and tips. It discusses the Seldinger technique for placement and locations for catheter insertion, including the internal jugular, subclavian, and femoral veins. Precautions are outlined for each approach. Ultrasound guidance is becoming standard to visualize the vein and compress it during insertion.
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This document discusses pulmonary artery pressure monitoring using a pulmonary artery catheter. It describes how Swan-Ganz catheters are inserted into the pulmonary artery to measure pressures. The document outlines the normal values of pressures in the heart and lungs. It also discusses how the catheter is used to monitor cardiac output through thermodilution and continuous cardiac output methods. Potential complications of the procedure are mentioned.
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Capnography
This document provides an overview of capnography including:
1) The objectives of describing ventilation, perfusion, and their relationship as assessed by capnography.
2) A description of the normal capnogram waveform and factors that can cause abnormal waveforms related to airway, breathing, and circulation problems.
3) Clinical applications of capnography including confirming endotracheal tube placement, assessing ventilation status, and predicting outcomes of cardiac arrest resuscitation.
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Blood pressure monitoring
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Central venous pressure monitoring
Pulmonary artery pressure monitoring
Mixed venous oxygen monitoring
Cardiac output
Extubation protocol in the OR and ICU
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Pulmonary artery catheterization
- 1. Pulmonary Artery Catheterization Dr. Md.Toufiqur Rahman MBBS, FCPS, MD, FACC, FESC, FRCPE, FSCAI, FAPSC, FAPSIC, FAHA, FCCP, FRCPG Associate Professor of Cardiology National Institute of Cardiovascular Diseases(NICVD), Sher-e-Bangla Nagar, Dhaka-1207 Consultant, Medinova, Malibagh branch Honorary Consultant, Apollo Hospitals, Dhaka and STS Life Care Centre, Dhanmondi drtoufiq19711@yahoo.com CRT 2014 Washington DC, USA
- 3. History • First Cardiac catheterization – ▫ According to Andre Cournand, it was first performed by Claude Bernard in 1844, in a horse, both rt and lt ventrilces were entered by retrograde approach from the jugular vein and carotid artery ▫ Werner Forssmann is credited with performing the first cardiac catheterization of a living person himself, at the age of 25 yrs • Forssmann for his contribution and foresight shared the Nobel Prize in Medicine with Andre Cournand and Dickinson Richards in 1956
- 4. History • 1929- Dr. Warner Forssman proven that right heart catheterization is possible in humans • 1964- Dr. Bradley introduced small diagnostic catheter • 1970- Balloon Flotation Catheter by Doctor H.J.C Swan and William Ganz
- 6. Technique for vascular access: The true “Seldinger™ technique” is not used for percutaneous puncture into vessels.
- 7. Vascular Sheath Percutaneous introduction and then the use of an indwelling vascular sheath in vessels is the standard technique for catheterization of pediatric and congenital heart patients. Ideal sheath should have: 1. Dilator 1. long, fine and smoothly tapered tip. 2. inner lumen of the dilator tip should tightly fit over the guide wire 3. tip of the dilator should have a smooth, fine transitional taper onto the surface of the wire. 2. female Lure™ lock connecting hub at the proximal end 3. back-bleed valve 4. Lateral tube / flush port
- 8. Vascular Sheath When introduced from the inguinal area, the sheath should be long enough to extend into the common iliac vein. In small infants a sheath into the femoral vein should extend proximal to the formation of the inferior vena cava.
- 9. Vascular Sheath Ideal short sheath (7.5 cm long) for venous site – 5 Fr for an infant or child (<15– 20 Kg) and 7 Fr for a larger child or adult Extra long sheaths (45 to 90 cm ) are used to – 1. guide catheters directly and repeatedly to an area within the heart itself (biopsies, blade catheters), 2. for trans septal procedures, 3. to deliver special devices within the heart or great vessels (stents, occlusion devices), and 4. for the withdrawal of foreign bodies from the vascular system.
- 10. Swan-Ganz Catheter(Pulmonary Artery Catheterization) • Swan-Ganz Catheter- Balloon flotation Pulmonary Artery catheter • Use for monitoring critically ill patients (mostly in the ICU) • Catheterization only possible on the right side of the heart • Catheter is hooked up to a Cardiac Output computer
- 12. Thank Youdrtoufiq19711@yahoo.com Asia Pacific Congress of Hypertension, 2014, February Cebu city, Phillipines Seminar on Management of Hypertension, Gulshan, Dhaka