PA Lines


Basics

1- What is a PA line?
2- Why are they sometimes called Swan-Ganz lines?
3- What are PA lines used for?
4- How are they inserted, and who inserts them?
5- Whats the difference between the introducer and the PA line?
6- What is a cordis?
7- What is the little syringe for?
8- What about the little balloon at the end whats that for?
9- Why do PA lines have multiple lumens?
10- Whats the difference between the colors : yellow, blue, white, purple?
11- Why do they call them ports?
12- What are the little black lines that show up along the length of the catheter?


Setting Up

13- How do I set up for a PA line insertion?
14- Why do we use a double-transducer setup?
15- How do I set up the monitor?
16- How do I set up the printer?
17- Where do I level the transducer?


Insertion

18- Who puts in the PA-line?
19- Why do they call it floating a Swan?
20- What are all those waveforms that I need to know?
21- When do I turn the printer on?
22- What does a normal CVP trace look like, and what are normal CVP numbers?
23- What does a normal RV waveform look like?
24- Why does everyone look nervous when the catheter tip is passing through the RV?
25- What does a normal PA trace look like?
26- Wedge trace?
27- What does stuck in wedge mean?
28- What do they mean when they talk about right-sided or left-sided pressures?
29- Why does the patient need a stat chest x-ray after the swan goes in?
30- Can I use the PA line before the film is read?
31- How do I make sure the line doesnt get pulled out?
32- What is the clear wrinkly sheath thing for?
33- What is the aluminum clippy thing with the sponge for?
34- Why is it important to put on an air-occlusive dressing?


Reading the numbers

35- Okay, the PA line is in, and the x-ray is read. How do I interpret the numbers?
36- How should I wedge the line?
37- What is overwedged?
38- What if I lose the syringe can I use another one?
39- What should I do with the syringe when Im not using it?
40- How often should I wedge the line?
41- How do I read the CVP?
42- How do I do a cardiac output?
43- Why do we delete the previous ones?
44- How many should I do?
45- What if the numbers make no sense?
46- Whats the difference between cardiac output and cardiac index?
47- Whats BSA?
48- What is SVR?
49- What is SV?
50- What are the classic patterns of numbers for different situations, like sepsis, or cardiogenic shock?


Using the ports

51- Which port should I use for what?
52- Can I infuse things through the distal PA port?
53- What goes through the CVP port?
54- Can I use the PA line for TPN?
55- Can I do blood draws from the PA line?
56- What is a Fick output, and how do I do one?


Bad things that can happen

57- What do I have to worry about when the line is going in?
58- How can I tell if those things are happening?
59- What do I do if the line is stuck in wedge?
60- What if the line pulls back to the RV?
61- What if the line gets pulled all the way out?
62- Why do they pull the line back to CVP?
63- What should I do with the ports and the transducers if the line is pulled back to CVP?
64- What if the balloon ruptures?
65- How do I know if that has happened?



PA-Lines


Basics

1- What is a PA Line?

A PA-line is a long multilumen catheter (a catheter with several tubes
in it, instead of just one), that is inserted through one of the large veins, and threaded through the right side of the heart, up into the pulmonary artery.


2- What are PA lines used for?

PA lines measure the pressures in the chambers of the heart: right
atrium (CVP), right ventricle (only when being threaded through the heart), then pressures in the pulmonary artery, and then the wedge pressure. When the balloon is deflated, the transducer sees the ambient pressures in the lungs. Wedge pressure is what the transducer sees as it looks through the catheter when the balloon at the end is inflated which seals the balloon against the walls of the PA vessel. Now the transducer is looking forward through the lungs, into the left side of the heart.

Sub-question 3a: How does the PA transducer look all the way through the lungs to see the left side of the heart? Arent they sort of in the way?

Answer: I have absolutely no idea, and Ive always wondered!

The wedge number reflects the pressure in the left ventricle at its fullest at the end of diastole so the wedge number is also sometimes called LVEDP: left ventricular end-diastolic pressure. If the pressure is high, then the idea is that the LV is having trouble emptying itself, maybe from ischemia, maybe from low EF, maybe from overhydration, maybe from cardiogenic shock. Too low, and the patient is probably dry.

PA lines are also used to calculate a set of numbers that can diagnose different conditions shock of various kinds, along with others. These numbers are specifically used when you want to figure out why a patients hemodynamics are acting strangely for example, someone whos gotten five liters of IV fluid, and whose blood pressure is still too low. The patterns of the numbers are usually very clear in critical situations, and can tell an experienced user almost immediately what the problem is (although if youre on your toes, you can often tell anyhow!)