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PA catheter and parameters

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by hyhero89 hyhero89 (Member)

1,923 Visitors; 16 Posts

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Hello all.

I am working in MICU and also studying critical care nursing.

As far as I know, It's a trend that PA catheter is not used anymore as much as it used to be in the past.

But my question is, when you study cardiovascular chapter in the books,

a large proportion of contents still covers hemodynamic parameters which can be obtained by PA catheter. (PAOP, Pumonary artery pressure, PAd, PAs, etc.)

So I am kind of lost how much I should put my efforts into this topics.

(I know I need to study hard but I don't think I can digest all the stuffs without some efficiency!)

Thank you so much for reading this.

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murse23 has 5 years experience.

1,214 Visitors; 18 Posts

I am also wondering about this. I am studying for my CCRN and some of the older study material includes them (Pass CCRN!) I don't use PA catheters on my unit so I don't have any actual experience with them. I am struggling with the concepts and trying to remember the normal values.

Does anyone know if there are generally any questions regarding PA catheters on the current CCRN tests?

if so, does anyone have any tips to remember?

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78 Likes; 6,908 Visitors; 909 Posts

I'm studying as well. I'm just kind of memorizing the numbers for them.

I guess it depends on when the test was revised. I notice my books cover it more than my apps do. I have the Laura Gasparis app.

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90 Likes; 1 Follower; 11,549 Visitors; 1,240 Posts

Just because PA catheters aren't used as frequently now (that pendulum may swing back, btw...) understanding pulmonary hypertension as a CC nurse is still very relevant. Instead of focusing on the textbook parameters of a PA catheter, instead focus on knowing pulmonary hypertension cold. There are five general categories of PHTN that are easily learned. Understand the effect it has on the right ventricle and return of blood to the left ventricle and therefore cardiac out put.

If you understand these concepts, there won't be a PA catheter question that you can't answer.

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1,923 Visitors; 16 Posts

Offlabel / Clearly understood. Thanks for your advice!

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49 Likes; 1,473 Visitors; 97 Posts

Even though these numbers can be obtained from a PAC doesn't mean they are exclusive to its use.  These numbers are important for understanding cardiac physiology and can be gathered through a right heart cath in the cath lab.

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hawaiicarl has 28 years experience as a BSN, RN and works as a Charge Nurse.

41 Likes; 6,676 Visitors; 285 Posts

I agree with murseman, and think his name is hilarious too.  Swan's aren't the only place you will see PA numbers, echocardiograms, and cath lab procedures usually include the information as well.  Pretty much the only patient I see with Swan's now is my post-op open hearts.  

Cheers

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90 Likes; 1 Follower; 11,549 Visitors; 1,240 Posts

PA measurement in the CCL are one time, kind of snap shot in time for diagnostic purposes only whereas, at least in theory, an indwelling PA catheter is for real time treatment decision making. Echos do estimate PA pressures but are notorious for underestimating them, ie, a "normal" PAP on echo does not rule out pulmonary hypertension. 

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CVICU RN 513 has 5 years experience as a BSN and works as a CVOR RN.

1 Like; 85 Visitors; 4 Posts

I never dealt with PAs in the MICU setting, but very often with open heart recovery. With the means to calculate SVI non-invasively PA caths aren't as necessary I suppose. As far as studying for CCRN I too felt that it was heavy on the PA stuff. I would focus on typical values and troubleshooting such as accidental wedging and appropriate waveforms.

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71 Likes; 4,810 Visitors; 370 Posts

I just recently took the adult CCRN, and there were plenty of questions on PA caths. Even if we aren't using PA caths it is still important to understand the hemodynamics.

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Pheebz777 has 18 years experience and works as a BSN-RN, CCRN-CMC-CSC, CEN.

4,094 Visitors; 215 Posts

Even though PA measurements are not routinely utilized, it is a great concept to grasp and understand. Many symptoms from various disease conditions reflect what is happening to your patient and understanding the pathophysiology behind these conditions make for better nurse anticipation and better patient outcomes.

For example: patient with existing COPD, stable BP (101/62), placed on BiPAP, has a drop on blood pressure after 30 mins, 88/45. If you understand what the BiPAP does to the pulmonary vasculature, you can understand why there's a drop in BP.

Or, what sepsis does to your SVR with subsequent drop in BP and compensatory response of your HR.

Just think of the cardiovascular system as a system of pipes and valves, just like the plumbing system in your house. Key things you need to keep in mind:

1. Direction of flow (IVC/SVC --->RA--->TV--->RV--->PV... etc)

2. What systems and/or chamber lies before and after each valve

3. The normal pressure values before and after each valve. (before=closed, after=open)

I would put a lot of effort into understanding these normal values, what they mean, and the effect of disease processes have on these parameters. To me, this is a very exciting concept to grasp.

But it doesn't end there. Once you've collectively put together your understanding of the RAAS, sympathetic/parasympathetic response, catecholamines, as well as your understanding of mechanism of actions of antiarrythmics, pressors, vasodilators, ventilator management, etc, everything just falls into place.

 

Edited by Pheebz777

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7 Likes; 674 Visitors; 23 Posts

PA Catheters are used frequently in our CVICU. You will not see them in use in any other specialty, only cardiothotacics.

The alternative option is a PICCO monitor, which I have used in MICU, but in Aus aren't used on a regular basis. 

 

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