Today our topic of discussion is Pulmonary Artery Wedge Pressure Monitoring.
Pulmonary Artery Wedge Pressure Monitoring
PULMONARY ARTERY WEDGE PRESSURE MONITORING
In August of 1970 Dr HJC Swan, Dr William Ganz et al. reported their results on use of a new flow-guided balloon- tipped catheter to measure pulmonary pressure in the critically ill client. At this time their discovery was a flexible double-lumen catheter capable of being inserted without fluoroscopy via the antecubital vein.
Now, the most the critical care nurses commonly are utilizing a four lumen pulmonary catheter to monitor different parameters of cardiac function. In addition to values displayed on the bedside monitor, e.g. pulmonary artery systolic, diastolic, and mean and wedge artery pressures. The four lumen catheter enables the nurse to perform cardiac output determinations at the bedside by thermodilution method.
Definition
- Swan-Ganz is a balloon tipped, flow directed catheter used to monitor pulmonary artery pressure. It implies artery with the catheter in the wedged position, so that the measurements recorded reflects left arterial presse (Figs. 29 100 and 29.101)
- Pulmonary artery wedge pressure monitoring implies pressure in a distal branch of pulmonary artery with the catheter in the wedged position, so that the measurements recorded reflects left arterial pressur This recorded using a balloon tipped, flow directed catheter called Swan-Ganz catheter.
Purpose
- To measure cardiac output by thermodilution method
- To obtain blood samples from the heart and pulmonary artery
- To monitor the hemodynamic pressures provides information about blood volume, fluid balance and how well the heart is pumping
- To measure direct pressure in the right atrium, night ventricle, pulmonary artery and distal branches of pulmonary artery the filling
- To infer the pressure in the left atrium and pressure of the left ventricle.
- To serve as a guide for fluid management
- To evaluate the successes of the drug therapy.
Principles
- The pulmonary artery wedge pressure is closely related to the left arterial pressure since there are no values in the pulmonary veins
- Left arterial pressure is closely related to the left ventricular end diastolic (filling pressure of the lett ventricle)
- When the catheter is wedged, it looks directly into the left side of the heart and is not influenced by the pressure in the pulmonary artery
- Pulmonary capillary wedge pressure is an indicator of the left ventricular function
- Continuous pulmonary artery pressure and intermine pulmonary artery wedge pressure measurement provide important information about left ventricular functi and preload.
Client and Equipment Preparation
- Explain the procedure in simple words to the client and relatives to reduce anxiety
- Obtain informed consent
- To obtain reliable pressure values and clear waveform the pressure monitoring system and bedside monitori must be properly calibrated and zeroed
- Make sure the monitor has correct pressure modules; then calibrate it according to the manufacturer’s instructions
- Turn the monitor on before gathering the equipment to give it time to warm up
- Be sure to check the operations manual for the monitor you are using; some old monitor needs 20 minutes to warm up
- Prepare the pressure monitoring system according to policy. Your faculty’s guidelines also may specific whether to mount the transducer on the IV pole or tape it to the client and whether to add heparin to the flush
- Make sure to have emergency resuscitation equipment on hand (defibrillator, oxygen and supplies for intubation and emergency drug administration).
Equipment
- Balloon tipped, flow directed PA catheter
- Prepared pressure transducer system
- Alcohol sponges
- Medication added label
- Monitor and monitor cable
- IV pole with transducer mount
- Emergency resuscitation equipment .
- Electrocardiogram monitor
- ECG electrodes
- Arm board (for antecubital insertion)
- Lead aprons
- Sutures
- Sterile 4″/4″ gauze pads or other dry, occlusive dressing material
- Prepacked introducer kit
- Optional: Dextrose 5% in water, shaving materials (for) femoral insertion site).
If a prepacked introducer kid is unavailable, obtain the following :
- An introducer (one size larger than the catheter)
- Sterile tray containing instruments for procedure
- Masks
- Sterile gowns
- Sterile gloves
- Povidone-iodine ointment and solution
- Solution
- Sutures
- Two 10 ml. syringes
- Local anesthetic agents (lignocaine 2%)
- One 5 mL syringe 25 G needle
- 1″ and 3″ tape.
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