By Peter Papadakos
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Additional info for Critical Care: A Volume in the Requisites in Anesthesiology Series
In order for the PAC to provide meaningful measurements of PCWP, the PCWP must always be measured at end-expiration in the respiratory cycle. Intrathoracic pressure variations differ between spontaneously breathing and mechanically ventilated patients (Figure 3-14). The saturation of the blood within the pulmonary capillaries, immediately prior to reoxygenation in the alveolar capillaries, is known as the mixed venous oxygen saturation SVO2. Since the diffusion of oxygen from End expiration PCWP Spontaneous ventilation I E I Positive pressure ventilation End expiration Time Figure 3-14 Determination of wedge pressure (PCWP).
Flushing of arterial catheters is an extremely important consideration in pediatric patients both with respect to flush volume as well as the possibility of cerebral embolization. The presence of an indwelling arterial catheter is independently correlated with the frequency of blood work drawn from any one particular patient. Therefore, arterial catheters correlate with the cost of ICU care. Biochemical laboratory analyses are frequently most easily drawn from arterial catheters. Routine monitoring of blood chemistries may phlebotomize an adult ICU patient at the rate of one unit of packed red blood cells per week.
Following insertion of the guide wire, with the J-tip leading, the introducer needle or catheter is withdrawn and a dilator is inserted. A scalpel is used to cut the skin at the insertion site and facilitate passage of the dilator and, ultimately, the catheter. The smaller the cut, the smaller the chance of lacerating the EJ vein, or cutting into the IJ vein. The scalpel tip should always be aimed laterally so that the chance of carotid puncture with the scalpel tip is minimized. If the dilator does not pass easily, it must not be forced since the possibility of lacerating a thin-walled vein exists.