Inherent variability in both PAP and PVR
Inherent variability of 8% in PAP and 13% in PVR over a given 6 hour period
Formulas for
(a) TPG
(b) DPG
(a) Transpulmonary gradient = PCWP - mPAP
> 10-12 suggestive of precapillary disease
(b) Diastolic pressure gradient = PCWP - PADP
> 7 suggestive of pre-capillary component
RHC risk percentage for
MI and CVA
RHC risk percentage
(a) 1:15,000 for MI and CVA (like .000066%)
RHC risk percentage for complications at access site
RHC risk percentages
Hematoma at insertion site 1-3%
Infection/phlebitis 1-3%
RHC risk percentage for
Arrythmia- most common ones?
(b) Arrythmia
3% VT
1.3% VF
<1% of RBBB
Preferred approach/location for insertion site for patients who need exercise challenge
IJ, femoral approach not feasible as exercise is performed on a supine cycle
If cannot use IJs need to look brachial
Suggested zero/level line
Level of the left atrium
fourth anterior intercostal space and halfway between anterior sternum and bed surface
Which wedge to record
Record wedge as mean of 3 measurements at end exhalation (at FRC where intra and extra thoracic volumes are equal)
How many cardiac outputs by Fick to obtain
For best accuracy obtain 3 measurements within 10% of each other
Why do measurements at end expiration
at functional residual capacity where intra and extra thoracic pressures are equal
Protocol at Lenox for vasoreactivity challenge
iNO @ 20ppm x5 minutes with oxygen flow at a minimum
After 5 minutes remeasure mPAP, PAWP, CO
Who gets fluid challenge
Pts with risk factors for HFpEF and borderline wedge of 12-15
How to perform fluid challenge
500cc bolus over 5-10 minutes
After infusion complete re-measure mPAP, PAWP, CO
What is considered positive fluid challenge
PAWP > 18 following administration of saline
Sizing of catheter for brachial vein approach
Must use 5F (can’t fit the usual 7F for femoral and IJ)
IJ or subclavian access site requires how much time for
(a) Manual compression after removal of 7F catheter
(b) Positional limitation
(b) Monitor site
IJ
(a) 7 minutes of manual compression
(b) No positional limitation
(c) Site monitored x1 hour
Femoral access site, how much time to monitor for
(a) Manual compression of access site
(b) Positional limitation
(c) Site monitoring
Femoral access site
(a) 7 minutes of manual compression)
(b) One hour bedrest
(c) One hour monitor site
