PA Catheters Competency

escape room - Case study

PA Catheters competency circus

Next

Good luck!

After successfully completing each section of questions, you will be awarded a ticket with a code number on it. You will need the number from each section to escape!

To complete this competency you will need to correctly answer various questions about pulmonary artery catheters and general hemodynamic monitoring.

Caring for a patient with a PA catheter can sometimes feel like a chaotic circus happening all at once with multiple different components.

PA Catheters Competency Circus

Although pulmonary artery (PA) Catheters are a valuable tool used for critical care hemodynamic monitoring, they are complex and high risk.

PA Catheters Competency Circus

Collect all 4 tickets to reveal the secret code to escape this crazy competency circus!

ok

Once you click start, the images on the cards will be hidden!

HINT:

START

After clicking "START" you will see a description of a part of the PA catheter and you must select the card that showed the correct component

PA Catheter Components

Memorize the cards

PA Catheter Components

Select the correct card:

question 1/7

Select the card of the part of the PA catheter...that occludes the pulmonary artery to obtain a "pulmonary capillary wedge pressure" measurement

Select the card of the part of the PA catheter...that leads to an opening in the right atrium and can be used to: obtain CVP measurements, infuse medications, obtain blood samples

PA Catheter Components

Select the correct card:

question 2/7

Select the card of the part of the PA catheter...that leades to the opening at the tip of the catheter and can be used to obtain PA pressure measurements & no blood samples except mixed venous blood gases

PA Catheter Components

Select the correct card:

question 3/7

Select the card of the part of the PA catheter...that is used to obtain cardiac output values through bolus thermodilution

PA Catheter Components

Select the correct card:

question 4/7

Select the card of the part of the PA catheter...that leads to a sensor which continuously reads the temperature of the blood in the pulmonary artery

PA Catheter Components

Select the correct card:

question 5/7

Select the card of the part of the PA catheter...that connects to the HemoSphere to obtain readings of the oxygen saturation of the blood in the pulmonary artery (SVO2)

PA Catheter Components

Select the correct card:

question 6/7

Select the card of the part of the PA catheter...that is used to inflate the balloon at the tip of the catheter

PA Catheter Components

Select the correct card:

question 7/7

PA Catheter Components

Congratulations!

You have obtained the first ticket & code number!

PA Catheters Competency Circus

Collect all the tickets to reveal the secret code to escape this crazy competency circus!

PA Catheter Set-up

question 1/5

Which color is typically the universal indicator for CVP?

Blue

Red

Yellow

PA Catheter Set-up

Question 2/5

Which color is typically the universal indicator for pulmonary arterial pressure?

Yellow

Red

Blue

PA Catheter Set-up

question 3/5

What anatomical landmark should the transducer(s) be kept level at for hemodynamic monitoring?

Xiphoid Process

Iliac Crest

Phlebostatic Axis

PA Catheter Set-up

correct!

The phlebostatic axis (4th intercostal space, midaxillary line) is teh reference point for hemodynamic monitoring because it is the level of the atria which accurately reflects central arterial pressure

Continue

PA Catheter Set-up

question 4/5

What type of IV fluid is required to perform cardiac output measurement via bolus thermodilution?

NS

D5W

LR

PA Catheter Set-up

Correct!

D5W is used to perform bolus thermodilution because it is the the IV fluid with the closest viscosity to blood. When measuring cardiac output by bolus thermodilution, you are attempting to mimick the flow of blood.

Continue

PA Catheter Set-up

question 5/5

To perform continuous cardiac output monitoring, what component must the PA catheter have?

Oximetry Connection

2nd Proximal Port

Thermal Filament

PA Catheter Set-up

Correct!

To continuously measure cardiac output, the PA catheter must have a thermal filament. When measuring CCO, the thermal filament emits a pulsed, low heat energy signal to warm the blood. The thermistor then detects this heated blood and uses an algorithim to calculate the C.O.

Continue

PA Catheter Set-up

Wonderful job!

You have obtained the second ticket & code number!

Collect all the tickets to reveal the secret code to escape this crazy competency circus!

PA Catheters Competency Circus

Waveform Analysis

question 1/10

Select which pressure waveform displayed below would reflect the pressure changes in the right atrium

Waveform Analysis

question 2/10

Select which pressure waveform displayed below would reflect the pressure changes in the pulmonary artery

Waveform Analysis

question 3/10

Select which pressure waveform displayed below would reflect the pressure changes in the right ventricle

Waveform Analysis

question 4/10

Select which pressure waveform displayed below would reflect the pressure changes when the pulmonary artery is occluded (wedge)

Waveform Analysis

question 5/10

Select which pressure waveform displayed below would reflect the arterial blood pressure

Waveform Analysis

question 6/10

Select which dynamic respose waveform is overdamped

Waveform Analysis

question 7/10

Select which dynamic respose waveform is underdamped

Waveform Analysis

question 8/10

Select which dynamic respose waveform is optimally damped

Waveform Analysis

question 9/10

Select the waveform that the red circle is indicating end expiration in a ventilated patient

Waveform Analysis

question 10/10

Select the waveform that the red circle is indicating end expiration in a non-ventilated patient

Waveform Analysis

Great work!

You have obtained the third ticket & code number

Collect all the tickets to reveal the secret code to escape this crazy competency circus!

PA Catheters Competency Circus

Putting it all together

question 1/5

An elevated pulmonary capillary wedge pressure measurement may indicate which condition?

Intravascular Volume Overload

Cardiogenic Shock

Pulmonic Valve Stenosis

When a patient is experiencing volume overload, this increases the pressure backing up from the left side of the heart into the pulmonary vasculature.

Putting it all together

Correct!

An elevated pulmonary capillary wedge pressure measurement may indicate volume overload.

Continue

Putting it all together

question 2/5

Your patient's PA pressure waveform suddenly looks like an RV waveform. What action should you take FIRST?

Pull catheter back until an RA waveform is seen

Advance catheter until a PA waveform returns

Adjust the monitor alarms

Putting it all together

Correct!

If you highly suspect the tip of a PA catheter is sitting in the patient's RV, this is an emergency and can quickly lead to VTACH.Per policy, you may pull the catheter back, but you may NEVER advance

Continue

Putting it all together

Question 3/5

Which condition might a decreased CVP waveform & measurement indicate?

Hypovolemia

Tricuspid Valve Stenosis

Right Sided Heart Failure

Putting it all together

Question 3/5

A decreased CVP waveform & measurement may indicate hypovolemia.CVP is a reflection of the right sided preload. If the CVP is low, it is highly likely the pressure in the right atrium is low due to hypovolemia.

Continue

Putting it all together

question 4/5

How should the syringe for the balloon port be maintained when not in use?

Empty & Locked

Full & Locked

Empty & Unlocked

Putting it all together

Correct!

The syringe for the balloon port should be kept empty and unlocked when not in use. This allows for any potential air to passively deflate back into the syringe

Continue

Putting it all together

question 5/5

When performing bolus thermodilution cardiac output measurement, what is required?

The Computation Constant

A HemoSphere Device

Mixed Venous Blood Gas

Putting it all together

Correct!

When performing bolus thermodilution cardiac output measurement, a computation constant is required.The computation constant is a number specific to each different type of PA catheter. This number is a correctional factor that accounts for the heat the D5W gains after it is injected. This allows the monitor to correctly calculate the temperature of the D5W when it enters the heart and then passes the thermistor to generate a C.O. value

Continue

Putting it all together

Well Done!

You have obtained thefinal ticket!

Collect all the tickets to reveal the secret code to escape this crazy competency circus!

PA Catheters Competency Circus

Enter secret code numbers

Try again

Incorrect!