RT Book, Section A1 Butterworth IV, John F. A1 Mackey, David C. A1 Wasnick, John D. SR Print(0) ID 1161425940 T1 Cardiovascular Monitoring T2 Morgan & Mikhail's Clinical Anesthesiology, 6e YR 2018 FD 2018 PB McGraw-Hill Education PP New York, NY SN 9781259834424 LK accessanesthesiology.mhmedical.com/content.aspx?aid=1161425940 RD 2024/03/29 AB KEY CONCEPTS The tip of the central venous pressure catheter should not be allowed to migrate into the heart chambers. Although the PA catheter can be used to guide goal-directed hemodynamic therapy to ensure organ perfusion in shock states, other less invasive methods to determine hemodynamic performance are available, including transpulmonary thermodilution CO measurements, pulse contour analyses of the arterial pressure waveform, and methods based on bioimpedance measurements across the chest. Relative contraindications to pulmonary artery catheterization include left bundle-branch block (because of the concern about complete heart block) and conditions associated with greatly increased risk of arrhythmias. Pulmonary artery pressure should be continuously monitored to detect an overwedged position indicative of catheter migration. Accurate measurements of cardiac output depend on rapid and smooth injection, precisely known injectant temperature and volume, correct entry of the calibration factors for the specific type of pulmonary artery catheter into the cardiac output computer, and avoidance of measurements during electrocautery.