Critical Care Skills Competency Myra Villaroman, MSN, RN Clinical - PowerPoint PPT Presentation

Critical Care Skills Competency Myra Villaroman, MSN, RN Clinical Educator

 Demonstrate how to set up for placement of PA catheter( Swan Ganz)  Able to assist physician with the insertion  Completes checklist and “Timeout” prior to procedure  Documents insertion using CLIP form  Demonstrate how to build a bridge  Documents education in EMR on infection prevention  Know how to correctly maintain PA catheter

 Obtain Informed consent/consent  Line cart( for supplies)  Vigilance II monitor( for CCO)  Pressure cables  Hand washing  Set up pressure lines and cables  Explain procedure to patient & family  Don PPE  Checklist/Time Out  Documentation: CLIP, site, size, depth,& readings( q6 hours & PRN)

 Intravascular pressure readings may have error introduced if alignment with the phlebostatic axis is not maintained. The amount of error introduced is dependent upon the degree of offset.  For every inch (2.5 cm) the heart is offset from the reference point of the transducer, a 2 mmHg of error will be introduced.

Parameters Equation Normal Range Arterial Oxygen Saturation 95-100% Mixed Venous Saturation(SvO2) 60-80% Central Venous Oxygen 70% Saturation (ScvO2) Arterial Blood Pressure (BP) Systolic (SBP) 100-140 mmHg Diastolic(DBP) 60-90 mmHg Mean Arterial Pressure (MAP) SBP + (2xDBP)/3 70-105 mmHg Right Atrial Pressure (RAP) 2-6 mmHg Central Venous Pressure(CVP) Pulmonary Artery Pressure (PAP) Systolic(PASP) 15-30 mmHg Diastolic(PADP) 8-15 mmHg Right Ventricular Pressure(RVP) Systolic(RVSP) 15-30 mmHg Diastolic(RVDP) 0-8 mmHg Mean Pulmonary Artery PASP+(2xPADP)/3 9-18 mmHg Pressure(MPAP) Pulmonary Artery Occlusion 6-12 mmHg Pressure(PAOP) Left Atrial Pressure( wedge) 4-12 mmHg Cardiac Output(CO) HRxSV/1000 4.0-8.0 L/min Cardiac Index(CI) CO/BSA 2.5-4.0L/min/ 𝑛 2 Stroke Volume (SV) CO/HRx1000 60-100 mL/beat Stroke Volume Index(SVI) CI/HRx1000 33-47mL/m2/beat Systemic Vascular 80x(MAP-RAP)/CO 800-1200dynes-sec/cm-5 Resistance(SVR) Systemic Vascular 80x(MAP-RAP)/CI 1970-2390 dynes-sec/cm-5/m2 Resistance(SVRI) Pulmonary Vascular 80x(MPAP-PAOP)/CO <250 dynes-sec/cm-5 Resistance(PVR) Pulmonary Vascular Resistance 80x(MPAP-PAOP)/CI 255-285 dynes-sec/cm-5/m2 Index(PVRI) Left Ventricular Stroke Work SVI x(MAP-PAOP)x0.0136 50-62 mmHg x ml/m2 Index(LVSWI) Right Ventricular Stroke Work SVI x(MPAP-CVP)x0.0136 5-10 mmHg x ml/m2 Index (RVSWI)

 1. The Swan-Ganz catheter should remain connected to the optical module during transport. Unplug the optical module cable from the Vigilance II monitor. Transport the patient.  2. If reconnecting to a different Vigilance II monitor, press the patient data button, select New Patient, select Yes, and Yes again.  3. Reconnect the optical module cable to the Vigilance II monitor.  4. Highlight and select oximetry large parameter frame. Select Recall OM Data. The calibration data stored in the optical module will be displayed.  5. If stored data is less than 24 hours old a Yes or No option will be displayed. Select Yes to begin oximetry monitoring.  If No is selected, In-Vivo calibration will be necessary.

 http://www.edwards.com/devices/Hemodyna mic-Monitoring/swan-ganz-catheters  YouTube videos