TAILIEUCHUNG - Cardiovascular Emergencies - Part 10

Thúc đẩy ống thông sẽ dẫn đến bong bóng qua van động mạch phổi báo hiệu sự gia tăng huyết áp tâm trương, thường là khoảng 40 cm đánh dấu. (6) Thức ăn ống thông vào động mạch phổi (nó thường là nhà nghỉ ở bên phải và vào khoảng 40-50 cm) | Cardiovascular Emergencies of these signs to appear indicates that the catheter has not crossed the valve and is merely curling round in an enlarged right atrium deflate the balloon and start again. 4 The balloon should now turn the corner and face cranially pausing for a few seconds may facilitate this as may asking the patient to take a deep breath. 5 Advancing the catheter will result in the balloon crossing the pulmonary valve signalled by an increase in diastolic pressure usually around the 40 cm mark. 6 Feed the catheter forward into the pulmonary artery it usually lodges on the right side and at around 40-50 cm . 7 The catheter should migrate distally into the wedged position. This can be confirmed by the characteristic forward motion of the catheter tip when the balloon is inflated and the bifid pressure trace. Deflation of the balloon should be followed by movement of the balloon backwards into the pulmonary artery the restoration of pulsatile motion and the re-appearance of the characteristic arterial pressure tracing Figure . Figure Pressure tracings obtained during pulmonary artery catheterisation. 350 Practical procedures The three most important rules in PA catheter placement are Never leave the catheter with balloon wedged for longer than it takes to make a PCWP measurement 40 seconds . Never pull the catheter back with the balloon still inflated. Always inflate the balloon slowly and monitor the pressure tracing during inflation. PCWP readings only represent left atrial pressure if the pulmonary capillary wedge pressure PCWP value is less than alveoiar This condition is only satisfied for the basal one-third of the lungs so called zone 3 . This region is readily identified in erect patients where a useful rule is to ensure that the catheter tip is always below the level of the left atrium. However in a supine patient this region can only be identified with a lateral chest x ray and this is unacceptably cumbersome for routine .

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