The BASICS of the Pulmonary Artery Catheter
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- เผยแพร่เมื่อ 16 มิ.ย. 2024
- Starting a new series talking about PA Caths. 📝 Free Quiz: adv.icu/3g4bYd6
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In this lesson, we are kicking off a new series talking about PA catheters. This is an introduction to the catheter and covers the basics of understanding what it is, why we use it, and some of the ports and values that come along with it. There is a lot to unpack over the next few lessons so dive right in!
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0:00 Intro
1:02 What is a PA Cath?
1:45 Relevant Anatomy
4:10 Anatomy of the PAC
9:41 Cardiac Output
12:54 SvO2
14:15 Indications/Contraindications
17:11 Wrap up
#ICUAdvantage #PAcath #swanganz
We LOVE swans in our ICU. Our lives revolve around it. As a new grad, this video was extremely helpful. I’ve binge watched all of your videos and you’re a literal lifesaver. We don’t learn this stuff in nursing school and you’ve been a huge contributor to my steep learning curve. Soo grateful for you and all that you do!!!
I'm a CVICU nurse. I work with Swans pretty much every day. Nice video, everything was spot on.
Appreciate that!
Another solid video brother! I can’t wait to share it with my orientees and new grads. You’ve broke it down perfectly. Thanks for what you do man!
I’m was waiting for this topic to come … cannot wait for the rest of this series …
I’m sharing it with love 🌹
Thanks a lot 🙏🏻
Thank you so much for the content! I recently just started training on taking open hearts, your videos have been extremely helpful.
Thank you so much! I’m ICU that transferred to the Cath Lab and do R Heart Cath all the time. Can’t wait for the video for explanation of different pressures ranges
Thank you so much,Eddie!
Great lecture. I definitely will continue to explore and comprehent your next lectures.It is a great resource for a cardiology student!
Greatly appreciate your time
I saw a swan catheter in my sisters car, she’s an ICU nurse manager and I had an idea of what it does and I wanted to ask her about all these different ports! But thank God I’ve just seen your video! I’ll keep replaying til it registers. Thanks for all you do! Can’t wait for the next one about all the pressures
I love u!!! New to CVICU and had a pt with this yesterday and I just hate feeling blind when I’m dealing with stuff.. thank you for your videos truly
I am lucky to find your channel before I took my BCCCP exam this September. It was a big help to prepare the test. I was an ICU RN only for 3 years and now I am working as a pharmacist. I hope many ICU pharmacists find this channel. I really love your high quality teaching video series. Thank you for sharing your knowledge. I really appreciate your effort.
Thank you so much! I'm in critical care clinical right now and Swans were just confusing me, they seemed great but I couldnt wrap my head around it until this video! thank you!!
This is my first time working with a swan gang catheter. This video gave me confidence, and a better understanding. Thank you.😊
This info is awesome!! I’m in an ICU who gets these catheters from time to time. Our training doesn’t break things down like you do! I feel like I can do do much more for my patients when I learn here! Thank you!!!
This is so awesome to read. I'm glad I was able to cover good information in a presentable way that you can apply it to the care you provide. So great.
Thanks! I hope all is well with you we've been missing you for a long time. I just joined the ICU community little over a month ago and am loving the world of intensive care. Also this content couldn't have come at a better timing. So great to see you releasing more videos. I have a midterm exam over this material on Monday, November 21. Hope more videos are to come relating to the exact specifics to the way forms between right sided versus left-sided pressure waveform. Thank you for all that you do for the entirety of the ICU community. Much love and all the best to you. Keep up the great work.
Thank you so much for this Ping!
Yeah, things got a bit busy with a move and job change and I feel behind, but back at it again now so we should be good moving forward!
Best of luck on your midterm and hopefully there will be some good videos here to help you along the way.
As for the pressures, the next lesson will be diving more into the pressures and waveforms of the SWAN.
Thank you so much for this video. This helped me understand so much more ❤️
You have a gift to teach, Eddie💖. The value of that cannot be measured, there are only a few good teachers. THANK YOU for sharing your knowledge💞😊.
Thank you so much for the awesome comment Elina. You are far too kind. Really glad you enjoyed it.
Eddy I passed my exams thanks to you... I really appreciate your help and encouragement ❤❤❤
Hi Eddie! Thank you for all the content! It is so helpful! I recommend your channel to all my ICU pals! I was wondering if maybe you could do some videos on the CCRN exam? I am starting to study for it and I am super nervous! But I would really appreciate you if you do decide to so some videos on the CCRN exam! Thanks Eddie!
Cheers!
This was fascinating. I'm a retired paramedic, but I had no idea these things were so complicated and could do so much. (Then again, we don't use them in the field.) My interest in learning more about them has been seriously piqued thanks to just having had a RHC two days ago because of a new dx of pulmonary HTN.
You're also a terrific instructor. I just subscribed.
Appreciate the comment. They really are fascinating!
Thanks so much for your videos. new to the ICU world and your vidoes are helpful. keep them coming LOL
Welcome to the wonderful world of ICU! Glad the vids have been helpful and I"ll definitely have more coming.
Perfect video to help with the “homework” assigned to me today by an interventionist.
This helped SO MUCH!!!! Thank you
So great to hear!!!
Thank you for the video, waiting on your next ones. Will you be making one on managing fresh heart patients?
Hi, please make video on capnography and EEG. REALLY love to see your informative videos
Great video! Could you do one on cardiopulmonary bypass? Thank you
Perfect timing! Just started in CVICU
Awesome! Congrats on the new CVICU position!
Just started working in cath lab..really help me understand..thank you
Awesome! Always looked fun back there!
Congrats on this marvelous presentation!
Side note, min 14:45 you correctly say cardiogenic versus non cardiogenic pulmonary edema, but type cardiogenic versus non pulmonary edema
I was a flight medic/CC medic for two years and I miss it sometimes. I’m enjoying your videos because they are a good refresher on skills I don’t use anymore. Thank you!
Ha I'm studying for my CCPC now!
@@skidy12 amen! Get after it! It’s an overwhelming yet fun field!
your classes are terrific! fantastic job. I can see a tremendous effort put in. What kind of software do you use to teach? best of best regards. thanks for sharing knowledge.
Thank you Sir
Thank you
After working in CVICU for a decade, I never watched this video because I know the topic so well. I was looking for something to send to my nursing students that are about to enter CVICU and this is perfect! Some of it was literally word for word the same spiel I give about a swan. 😂 Thank you so much! This will be so helpful to them
This is so awesome to read. Thanks for that and glad to hear it sounds like it would be similiar to how you'd present it as well 😊
Great info!
Thank you!! :)
Thank you!! 🥰
You are so very welcome Kristin!!! ❤️
Hi, thanks for the video. I have a question please, and I do hope I get an answer before my exam on Friday morning. How do you flush the port when you draw a blood sample from the yellow port for SVo2? Still with normal saline? is that safe since the port is in the pulmonary artery heading to the lungs?
hi Eddie, I’m a nursing student that’s got a job lined up in a CVICU. I’m wondering if you could do a video / series going through ICU assessment? Or how to / receive report? just a suggestion. I love all the content and will use it as I start next summer.
Thanks for the suggestion Janak. I do have those as items on the todo list. Just not sure when I'll get to them yet.
Hey there, I'm a CVICU nurse. Of course your head to toe is important, but doing multiple focused assessments each shift is how you stay on top of things. Recognising changes however small can be the difference. For example, patient is on day 3 of post op recovery for their CABG surgery? Look for irregular heartbeats on their rhythm (atrial fibrillation typically happens on day 3 CABG post-op). How about they're fresh from the OR and you're bedside for the next 2 hours recovering them? Watch for a slow and steady drop in blood pressure with narrowing pulse pressures and maybe it also seems like their heart sounds are getting further away? For some reason your chest tube output dropped to nothing? Tamponade. Call CTSurg ASAP. you'll learn so much
@@ohiovstheworld hi!! thank you so much for the response. i certainly agree with you. im trying to prep as best as i can prior to starting next year. i’ll definitely continue to shadow more on the unit and get my focused assessments down. appreciate any recommendations you may have (things to know, resources, etc.) so far, i’ve been using ICU advantage and an icu nursing book. thank u :)
@@ICUAdvantage i just wanted to add that i love how easy you’ve made all your content to digest and understand. thank you for all this
@ICU ADVANTAGE Thank you for your dedication and time in making these great Videos!!! I am a bit confused about how PAWP helps in estimating the LAP? LAP and LVEDP different or tells the same thing? Thank you!
Great question....
So simple answer, we can, normally think of the two in the same way. In actuality, they are different measures and can have different values (typically LVEDP will be slightly higher) and different effects on physiology can change this.
But basically, they both are used to evaluate preload of the LV.
Good one
Hi, love this video! Tiny question while studying for my exam: the lesson says that when on ECMO or extracorporeal circuit you should never inflate the balloon/move the position of the katheter. I wonder why this is? Thank you!
It depends on your patient’s cannulation approach! I don’t want to go too in depth but there are cannulae locations for venous, arterial, wether it’s peripheral or central, etc. rarely is there every a case where you could say “never touch a swan when on ECMO, inflate, wedge, reposition, etc. textbooks are notorious for lacking that sort of detail.
Hey man, great content! I signed up to the membership for the notes, where can we get those?
Hey Charles! Thank you so much for your support with membership.
Sorry for the confusion on the notes as TH-cam doesn't make it easy to know where to go. If you go to the main ICU Advantage TH-cam page, then click the "Community" tab, and then look for the most recent post with the link and current password. The password changes each month so just always look for the most recent one.
Feel free to shoot me an email if you have any other issues!
can you make a video on impella’s!
Love your videos! Thank you for your hard work.
*Thermistor
Glad you enjoy them! Thanks Ryan
Hello! Thank you so much for your video! I would like to request clarification on where the VIP/proximal infusion port, and the CVP/ proximal injectate port terminate. When I've measured the PA catheter the CVP terminates at 26cm, and the VIP terminates at 30cm. Do these vary from catheter to catheter?
Yes definitely vary based on type of cath and manufacturer!
Thanks
Thank you so much for this Fatima! I appreciate you! ❤️
Hi! One question I can't find the answer to: why is venous oxygen saturation very low when you take a venous blood gas from a peripheral katheter in the arm (like 30%) and why is the central or mixed venous oxygen saturation higher (like 75%)? Is it because addition of blood from the vena porta? Thank you!
Obrigado!
Thank you so much for this!
correct me if im wrong but shouldnt the red lumen syringe be filled with some kind of fluid, if its inflated with 1,5ml of air, and im in no case an expert on this, and the baloon ruptres that would definetly cause Air embolism so close to the lungs
Hey Eddie, I have a question. How does the Swan-Ganz catheter account for the other lung. Given it’s placement, couldn’t there be a significant difference between the pulmonary resistance / wedge pressure between the right and left lung? Also, isn’t the L lung slightly “smaller” given the space the heart takes in the left chest, and isn’t the R lung most often affected by things like aspiration etc.? Is that something that is considered when interpreting these values? Great video! Thanks for everything you do.
Pawp is useful as a surrogate LA pressures, technically LVEDP, taking into regard deviations, to build a clinical picture, such as PE, edema, etc. That's because there are no valves between the the PA (both R and L) and the LA. It's a surrogate, to get an accurate pressure, a cardiologist (particularly interventionalists)would have to float a cath through the Ao into the LV.
@@henry2009 yeah, that makes sense, I suppose it doesn’t make a difference which side it would be on, it’s a continuous vessel with the LA. Dependent on the LA and forward flow through the Mitral valve. Hmmm. Interesting concept
@@henry2009 now that you say it that was a pretty stupid question. It’s a static number, not like the PA pressure that has a systolic and diastolic pressure. Ugh 🤦♂️
Hey Douglas.
So, technically, yes there are potentially some slight variations between pressures in the left and right and certainly differences in anatomy, physiology and other extenuating factors can all influence these pressures, and they are all necessarily even.
That said, in most cases, the slight differences are going to be negligible and not something that we are accounting for in any way. Whether the PA Cath has ended up on the right or the left, in most cases, clinically, it doesn't matter to us in our numbers and our management.
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can you get Svo2 from the blue line (CVP line?)
Nope. That would be an ScvO2 you'd be drawing. Missing lower body and coronaries
Angioedema patho/management?
Great video. But I guess you mean PAP= left side pressure.
Can you give me a time you are referring to so I can see what you are talking about?
That said, PCWP/PAOP would be left sided preload. Pulmonary Artery Pressure (PAP) would be right sided pressure (like an aline for the right heart).
The only person I trust to do my pic line at UCI . His man is ED
Any new videos soon????
Yeah got tied up with stuff but should be out Monday!
What's the benefit of this over a central line? When would you choose one over the other? ty
This is specifically going to be for the purpose of evaluating cardiac function in most cases, or in cases of pulmonary hypertension. Towards the end of the lesson I talk about some of the use cases. That said, oftentimes these patients will have central lines as well. While we can give fluids/meds through the white proximal infusion port, thats not its main purpose and therefore we still primarily use IV/Central Lines for that stuff.
@@ICUAdvantage Oh that makes a lot of sense. Thank you!