肺动脉漂浮导管PAC

Heart failure ；Decompensated cirrhosis
2020-12-08 • Ventilator management 肺动脉漂浮导管PAC（新课件）
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Contents
Introduction
PAC Placement
Hemodynamic Monitoring Controversy on PAC
• Guide to pharmacologic therapy
Vasopressors； Inotropes ； Vasodilators
• Guide to nonpharmacologic therapy
Fluid management ；Burns ；
Renal failure ； Sepsis ；
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What is Pulmonary Artery Catheter ?
• Full name: Swan-Ganz Catheter
• Used it to monitor a patient’s hemodynamics when we cant answer the question using noninvasive/clinical measures
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Clinical use of the PAC（Therapy）
• Management of perioperative patient with unstable cardiac status
• Management of complicated myocardial infarction
• Management of severe preeclampsia
RAP
80 – 100 milliseconds RA systole after P wave
a wave
RA diastole
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肺动脉漂浮导管PAC（新课件）
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Clinical use of the PAC （Diagnosis）
• Differentiation among causes of shock
Cardiogenic
Hypovolemic
Distributive (sepsis)
Obstructive (massive pulmonary embolism)
肺动脉漂浮导管PAC（新课件）
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PAC on CRX（PA）
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肺动脉漂浮导管PAC（新课件）
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Placement of the catheter
2020-12-08
Hale Waihona Puke Baidu
肺动脉漂浮导管PAC（新课件）
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Right Atrium
>>20 cm
Normal right atrial presssure is 0-6cmHg.
• Always inflate the balloon before advancing the PAC and always deflate the balloon before withdrawing the PAC.
• CRX：check the position of the PAC
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PAC insertion
• After inserting the PAC as far as the 20cm mark，the balloon is inflated with air.
• Inflation should be slow and controlled (1 mL/s) and should not surpass the recommended volume (1.5 mL).
• Differentiation of pulmonary edema
Cardiogenic
Noncardiogenic
• Evaluation of pulmonary hypertension
• Diagnosis of left-to-right intracardiac shunt
2020-12-08 • Diagnosis of peri肺c动a脉r漂d浮i导a管lPAtCa（m新课p件o） nade
Normal oxygen content 15%（ml/dL)
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Normal O2 s肺at动u脉r漂a浮ti导o管nPA7C5（%新课件）
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Waveforms of CVP
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肺动脉漂浮导管PAC（新课件）
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EKG-RAP
EKG
Mechanical event
肺动脉漂浮导管PAC（新课件）
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Comparison among PA catheter insertion sites
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肺动脉漂浮导管PAC（新课件）
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PAC insertion
• Right internal jugular vein Shortest and straightest path to the heart
• Left subclavian Does not require the PAC to pass and course at an acute angle to enter the SVC
• Femoral veins
Distant sites
Passing 2020-12-08 a PAC into the 肺h动e脉a漂r浮t 导c管aPnAC（b新e课件d）ifficult
肺动脉漂浮导管PAC
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Contents
Introduction
PAC Placement Hemodynamic Monitoring
Controversy on PAC Parameter integration
Cases Discussion
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肺动脉漂浮导管PAC（新课件）
Parameter integration
Cases Discussion
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肺动脉漂浮导管PAC（新课件）
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Structure of PAC
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肺动脉漂浮导管PAC（新课件）
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PAC
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肺动脉漂浮导管PAC（新课件）
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首选：右颈内静脉
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