(2020年)肺动脉漂浮导管PAC(最新课件)

❖ Always inflate the balloon before advancing the PAC and always deflate the balloon before withdrawing the PAC.
❖ CRX：check the position of the PAC
❖ PA diastolic pressure ~ PAWP
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PAC
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首选：右颈内静脉
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Comparison among PA catheter insertion sites
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PAC insertion
❖ Right internal jugular vein Shortest and straightest p0-11-23
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Contents
Introduction PAC Placement
Hemodynamic Monitoring Controversy on PAC
Parameter integration
Cases Discussion
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Structure of PAC
a wave x descent
After QRS
Tricuspid valve closure
c wave
❖ Left subclavian Does not require the PAC to pass and course at an acute angle to enter the SVC
❖ Femoral veins Distant sites Passing a PAC into the heart can be difficult Fluoroscopic assistance may be necessary Compressible and preferable if the risk of hemorrhage is high
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Clinical use of the PAC （Diagnosis）
❖ Differentiation among causes of shock Cardiogenic Hypovolemic Distributive (sepsis) Obstructive (massive pulmonary embolism)
❖ Differentiation of pulmonary edema Cardiogenic Noncardiogenic
❖ Evaluation of pulmonary hypertension ❖ Diagnosis of left-to-right intracardiac shunt ❖ Diagnosis of pericardial tamponade
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PAC on CRX（PA）
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Placement of the catheter
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Right Atrium
>>20 cm
Normal right atrial presssure is 0-6cmHg.
Normal oxygen content 15%（ml/dL)
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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).
肺动脉漂浮导管的应用
Contents
Introduction PAC Placement
Hemodynamic Monitoring Controversy on PAC Parameter integration
Cases Discussion
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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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Vasopressors； Inotropes ； Vasodilators ❖ Guide to nonpharmacologic therapy
Fluid management ；Burns ； Renal failure ； Sepsis ； Heart failure ；Decompensated cirrhosis ❖ Ventilator management Assessment of best PEEP for DO2
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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 ❖ Guide to pharmacologic therapy
Normal O2 saturation 75%
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Waveforms of CVP
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EKG-RAP
EKG
Mechanical event
RAP
80 – 100 milliseconds RA systole after P wave
RA diastole