RT Book, Section A1 Butterworth, John F. A1 Mackey, David C. A1 Wasnick, John D. SR Print(0) ID 57230594 T1 Chapter 5. Cardiovascular Monitoring T2 Morgan & Mikhail's Clinical Anesthesiology, 5e YR 2013 FD 2013 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-162703-0 LK accessanesthesiology.mhmedical.com/content.aspx?aid=57230594 RD 2022/06/24 AB The central venous pressure catheter’s tip should not be allowed to migrate into the heart chambers. Although the pulmonary artery 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 measurements and pulse contour analyses of the arterial pressure waveform. 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, such as Wolff-Parkinson-White syndrome. 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.