Central Venous and Arterial Lines and Pulmonary Artery Catheters (Swan-Ganz) - Lecture Notes

Vocabulary flashcards covering key terms related to central venous access, arterial lines, and Swan-Ganz pulmonary artery catheters, including placement, measurement principles, safety considerations, and common complications.

Central line (central venous catheter)

Catheter placed in a central vein (IJ, subclavian, or femoral) for CVP monitoring, IV drug administration, and venous blood sampling; some are tunneled (e.g., Hickman).

PICC line

Peripherally Inserted Central Catheter; central venous access via the arm for IV therapy and labs.

Internal jugular vein (IJ)

A common site for central venous access in the neck.

Subclavian vein (SC)

Central venous access site near the shoulder; risk/benefit considered due to infection and pneumothorax risk.

Femoral central line

Central venous access through the femoral vein; higher infection risk and patient mobility considerations.

Hickman catheter

Tunneled, long-term central venous catheter placed under the skin to reduce infection risk.

Chest X-ray after thoracic line

Imaging to confirm line tip location and to exclude pneumothorax after placement.

Tip location: SVC/right atrium

Goal tip placement at the superior vena cava or just outside the right atrium; malposition can cause complications.

Right atrium (RA) position

Tip sitting in the RA increases risk of arrhythmias; requires repositioning.

Right ventricle (RV) position

Tip in the RV can cause ventricular tachycardia; immediately withdraw to a safer position.

Pulmonary artery catheter (Swan-Ganz)

catheter used for hemodynamic monitoring, cardiac output by thermodilution, and sampling of blood pressures and saturations.

Pulmonary artery wedge pressure (PAWP / wedge)

Left-sided preload estimate obtained by occluding the PA with a balloon; reflects left atrial pressure.

Red port (wedge port) on Swan-Ganz

Port closest to the end used to obtain wedge pressure; use the specified 1.5 mL limit syringe.

Blue port on Swan-Ganz

Port near the end used for sampling pressures (PA/venous) depending on catheter design.

Thermistor

Temperature sensor on the Swan-Ganz catheter used to calculate cardiac output via thermodilution.

Thermodilution

CO measurement method: inject a known volume of saline and measure temperature change across the thermistor to compute cardiac output.

Mixed venous oxygen saturation (SvO2)

Venous O2 saturation from the pulmonary artery; normal range approximately 70–85% in this course; reflects overall oxygen extraction.

Central venous oxygen saturation (ScvO2)

Venous O2 saturation measured in the superior vena cava; used similarly to SvO2 for assessing oxygen delivery/extraction.

Arterial line (A-line)

Catheter in an artery (commonly radial) for continuous real-time blood pressure monitoring and arterial blood gas sampling.

Mean arterial pressure (MAP)

Average arterial pressure: MAP ≈ (Diastolic × 2 + Systolic) / 3; goal typically ≥ 70 mmHg.

Dicrotic notch

Notch on an arterial waveform representing aortic valve closure; loss or flattening may indicate line issues.

Zeroing

Calibrating the transducer to atmospheric pressure at the start of a shift or after repositioning.

Leveling (transducer at heart level)

Positioning the transducer at the level of the right atrium (phlebostatic axis) for accurate readings; re-level after movement.

Phlebostatic axis

Anatomical reference point used to zero and level pressure transducers.

Line flush every 4 hours

Regularly flush lines to maintain patency and prevent clotting; common practice is about every four hours.

Line dressings

Check and maintain line dressings at assessments; replace or reinforce as needed to prevent infection.

Dressing change interval (72 hours)

Line dressings are typically changed every 72 hours or as needed based on sterility and condition.

Pigtail stopcock

A valve on the infusion line used to flush; ensure the stopcock is open during checks and flushing.

Infection signs with lines

Fever or localized signs; if infection suspected, obtain cultures and remove the catheter if indicated.

Line disconnection/waveform loss

Loss of waveform or abrupt changes may indicate disconnection or kinking; troubleshoot before continuing.

Air embolism risk

Air entering the line can cause embolism; use proper syringes and ensure closed system; never push air through lines.

Pulmonary embolism risk with Swan

Balloon or catheter mismanagement can cause emboli; deflate balloon promptly and manage line carefully.

Ventricular tachycardia from catheter in ventricle

Catheter entering the RV can trigger VT; withdraw the catheter promptly and notify the provider.

Pulseless electrical activity (PEA)

Electrical activity without a palpable pulse; treat as cardiac arrest with CPR and underlying cause assessment.

Arterial blood gas sampling with A-line

Access arterial blood for ABG via the arterial line; consider patient comfort and infection risk.

Swan-Ganz syringe limit (1.5 mL)

Use only the dedicated 3 mL syringe with a 1.5 mL plunger limit for wedge measurements; others must not be used.

Swan-Ganz balloon occlusion

Balloon inflation to occlude the pulmonary artery for wedge pressure measurement; deflate after reading to avoid ischemia or embolism.

Pacing Swan-Ganz

Some Swan-Ganz catheters include pacing wires as an optional feature.

Intermittent vs continuous thermodilution

CO measurement options: intermittent injections vs continuous thermodilution with a plugged system.

Cardiac output interpretation

CO readings are one data point; interpret within the clinical context of the patient and other vitals.

Infection prevention with lines

Vigilant site care, sterile technique, and prompt management of possible infection to prevent sepsis.

Valve issues and wedge pressure

Elevated wedge pressure suggests left-sided preload problems or valve dysfunction; interpret with clinical context.

Correlating arterial and cuff BP readings

Compare invasive arterial pressures with noninvasive cuff pressures to identify line issues or cuff problems.

Ventilator care and line monitoring

In ventilated patients, ABGs and line readings guide therapy; ensure line integrity during care activities.