RT Book, Section
A1 Butterworth IV, John F.
A1 Mackey, David C.
A1 Wasnick, John D.
SR Print(0)
ID 1206709062
T1 Cardiovascular Monitoring
T2 Morgan & Mikhail’s Clinical Anesthesiology, 7e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781260473797
LK accessanesthesiology.mhmedical.com/content.aspx?aid=1206709062
RD 2024/10/15
AB KEY  CONCEPTS  The  tip  of  the  central  venous  pressure  catheter  should  not  be  allowed  to  migrate  into  the  heart  chambers.  Although  the  pulmonary  artery  (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  cardiac  output  (CO)  measurements,  pulse  contour  analyses  of  the  arterial  pressure  waveform,  and  methods  based  on  bioimpedance  measurements  across  the  chest.  Relative  contraindications  to  PA  catheterization  include  left  bundle-branch  block  (because  of  the  concern  about  complete  heart  block)  and  conditions  associated  with  a  greatly  increased  risk  of  arrhythmias.  Pulmonary  artery  pressure  should  be  continuously  monitored  to  detect  an  overwedged  position  indicative  of  catheter  migration.  Accurate  measurements  of  CO  depend  on  rapid  and  smooth  injection,  precisely  known  injectant  temperature  and  volume,  correct  entry  of  the  calibration  factors  for  the  specific  type  of  PA  catheter  into  the  CO  computer,  and  avoidance  of  measurements  during  electrocautery.