swan - SWAN GANZ CATHETERS Introduction Introduced by Swan...

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SWAN GANZ CATHETERS
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Introduction • Introduced by Swan & associated in 1970 • Balloon tipped, flow directed catheters • Rationale for use: – Clinical observation subjective/inadequate in critically ill – Allow measurements of determinants & consequences of cardiac performance [Pre-load, Afterload, CO] Essential for management of unstable Patients
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Indications • Assessment of Shock: – Cardiogenic, Hypovolemic – Septic, Pul. Embolism • Assessment of Resp. Distress: – Cardiogenic Vs Non-Cardiogenic • Management of Complicated MI: – Hypovolemia Vs Cardiogenic Shock – VSD with MR – Severe LVF – RV Infarction
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• Assessment of Therapy in Selected Individuals: – Afterload reduction in patients with severe LVF – Inotropic agent – Vasopressors • Management of Post-Op Open Heart Surgical Pts. – Assessment of cardiac tamponade – Assessment of Valvular heart disease
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•Assessment of Fluid Requirements in Critically Ill Pts. – GI hemorrhage Sepsis – ARF Burns – Decompensated Advanced peritonitis Cirrhosis
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• Made of PVC • Coated with Heparin - Reduce Thrombogenicity • Std length: 110cm - Ext-diameter; 5-7 Fr • Balloon at tip - Guides the catheter (Air filled) Minimizes endocardial damage or arrhythmia • Double lumen - Balloon inflation - Measure intravascular pressure/Sample blood
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• Triple lumen - Simultaneous measurement of RA, PA pressure • 4 Lumen - CO measurements via thermiostor (most commonly used) • 5 lumen - Central venous access for fluid/ medicine infusion Special Purpose • Pacing Catheter - 2.4 Fr. bipolar pacing electrodes - Intra cardiac pacing • Continuous SvO 2 - Catheter
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Insertion Techniques • Inserted percutaneously or via cut down into basilic, brachial, femoral, sub-clavian or internal jugular veins • Internal jugular vein approach preferred: – Pt. Arm movements not encumbered – Used in pts. undergoing intra-thoracic Sx – Fewer thrombotic/septic complications may occur
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• Insert Central Venous Cannula Position the guidewire in vein Vessel dilator sheath apparatus advanced into vessel Remove guidewire and vessel dilator leaving introducer sheath in vessel Pass the catheter through the introducer sheath into vein
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Advance it until tip reaches RA (Antecubital fossa: 35-40cm, Int. Jugular vein 10-15cm, sub clavian vein 10cm, Femoral vein 35-40cm) Obtain RA blood for O 2 saturation from distal port, record RA pressure Inflate balloon with recommended amount of air. Advance catheter until RV pressure tracing seen on monitor Obtain and record RV pressures
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Advance into PA (Diastolic pressure tracing rises above that in RV) Further advancement results in fall in the pressure tracing from the systolic pressure in RV and PA, record PAWP. Deflate balloon Secure catheter in position by suturing it to skin CXR: To confirm position Catheter tip should appear 3–5 cm from midline
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This note was uploaded on 12/03/2011 for the course MEDICINE 350 taught by Professor Dr.aslam during the Winter '07 term at Medical College.

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swan - SWAN GANZ CATHETERS Introduction Introduced by Swan...

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