Name:
AccessAnesthesiology - Pulmonary Arterial Catheterization
Description:
AccessAnesthesiology - Pulmonary Arterial Catheterization
Thumbnail URL:
https://cadmoremediastorage.blob.core.windows.net/ffdd8c5a-7824-4830-9e09-976a60bbb82d/thumbnails/ffdd8c5a-7824-4830-9e09-976a60bbb82d.jpg?sv=2019-02-02&sr=c&sig=y5zOqRixtB0HlHgqXt1K67j8ekyysImdd5rKocnOeOU%3D&st=2023-05-30T07%3A17%3A21Z&se=2023-05-30T11%3A22%3A21Z&sp=r
Duration:
T00H05M19S
Embed URL:
https://stream.cadmore.media/player/ffdd8c5a-7824-4830-9e09-976a60bbb82d
Content URL:
https://asa1cadmoremedia.blob.core.windows.net/asset-89077b10-c73e-458b-b0ed-a59fbec8818b/Pulmonary20arterial20catheterization.mov
Upload Date:
2022-02-27T00:00:00.0000000
Transcript:
Language: EN.
Segment:0 .
The skin over the procedure site is prepped widely using a topical antiseptic solution. Here, the operator repairs the skin over the right internal jugular location prior to draping.
Segment:1 Draping.
The operator gowns, gloves, and masks prior to applying drapes to the procedure field.
Sterile drapes are placed around the procedure site, covering a wide area and all skin services. The area should be draped widely enough to prevent contamination of any of the instrumentation used during the procedure. The operator must ensure that the draped area does not migrate outside of the prepped area during the course of the procedure.
Segment:2 Catheter Insertion.
The operator prepares to catheterize the right internal jugular vein and begins by palpating the carotid artery. Having identified arterial pulsations, the operator advances a finder needle just lateral to the carotid, into the internal jugular vein. Using the finder needle as a marker, the operator advances a second needle through catheter into the vessel along the same track.
Once the operator has confirmed blood flow, the finder needle is removed, and the catheter is threaded over the needle, into the vessel. The pressure in the vessel that has been catheterized is then transduced in order to ensure that the carotid artery has not been inadvertently cannulated. Here, both the color of the blood and the height of the column are consistent with venous cannulation.
A small wire is then introduced to the catheter into the vessel, as consistent with the Seldinger technique. The wire will be used to exchange the small catheter for the pulmonary artery introducer catheter. The needle site is enlarged with a scalpel incision to accommodate the larger introducer catheter.
Finally, the introducer catheter with a dilator is threaded over the wire into the vessel. The dilator is then removed and the introducer is sown into place.
Segment:3 Ultrasound.
Ultra-stenography maybe used as an alternative method of vessel location. The operator applies an ultrasound probe over the vessel of interest. Here, the operator interrogates the skin over the right internal jugular vein and slowly advances the catheter into the vessel. You can see the vessel being compressed as the catheter is advanced.
Segment:4 Balloon Testing.
The balloon is inflated for testing prior to pulmonary artery catheter insertion. The balloon should inflate and deflate readily. The catheter is inserted to a depth of 20 centimeters. The balloon is then inflated and the catheter floated through the cardiac chambers following waveforms.
Between 20 and 30 centimeters, the catheter tip typically passes through the superior vena cava prior to entering the right atrium. The catheter typically enters the right ventricle at about 30 to 35 centimeters and the waveform becomes pulsatile consistent with ventricular contraction. The balloon tip typically passes into the pulmonary artery at about 45 to 50 centimeters, and the diastolic pressure increases, and the waveform develops a dicrotic notch.
Once the catheter tip is in the pulmonary artery, the balloon can slowly be advanced to the wedge position. When the balloon becomes fully wedged, the pulsatile pulmonary arterial trace will no longer be evident. The balloon must be fully deflated at the conclusion of the procedure.
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