Today our topic of discussion is Procedure of Pulmonary Artery Wedge Pressure Monitoring.
Procedure of Pulmonary Artery Wedge Pressure Monitoring
Procedure
- Check the client’s chart for heparin sensitivity, which contraindicates adding heparin to the flush solution Position the client at the proper height and angle, if the doctor will use a superior approach for percutaneous insertion
- Place the client flat or in a slight trendelenburg position, remove the client’s pillow to help engorge the vessel and prevent air embolism
- Turn his head to the side opposite the insertion site If the doctor will use an inferior approach to access a formal vein, position the client flat, be aware that with this approach, certain catheters are harder to insert and may require more manipulation
- Maintain aseptic technique and use standard precautions throughout catheter preparation and insertion
- Wash hands, then clean the insertion site with a povidone-iodine solution and drape it Put on a mask, help the doctor put on a sterile mask, gloves and gown.
- Open the outer packing of the catheter, revealing the inner sterile wrapping. Using aseptic technique, the doctor opens the inner wrapping and picks up the catheter
- To remove air from the catheter and verify its patency, flush the catheter.
- Assist the doctor as he inserts the introducer to access the vessel. He may perform a cut down or insert the catheter percutaneously, as with a modified Seldinger technique
- After the introducer is placed and the catheter lumens are flushed, the doctor inserts the catheter through the introducer in the internal jugular or subclavian approach, he inserts the catheter into the end of the introducer sheath with the balloon deflated, directing the curl of the catheter toward the client’s midline
- Using a gentle, smooth motion, the doctor advances the catheter through the heart chambers, moving rapidly to the pulmonary artery because prolonged manipulation here may reduce catheter stiffness
- As the catheter floats into the pulmonary artery, note that the upstroke from right ventricular systole is smoother and systolic pressure is nearly the same as right ventricular systolic pressure
- Record systolic, diastolic and mean pressure (typically ranging from 8 to 15 mm Hg)
- To obtain a wedge tracing, the doctor lets the inflated balloon float downstream with venous blood flow to a smaller, more distal branch of the pulmonary artery
- Conform the catheter position by obtaining chest X-ray
- Apply a sterile occlusive dressing to the insertion site.
Checking a PAWP Reading
- PAWP is recorded by inflating the balloon and letting it float in a distal artery
- To begin, verify that the transducer is properly leveled and zeroed
- Take the pressure reading at end expiration.
- Note the amount of air needed to change the PA tracing to a wedge tracing (normally 1.25-1.5 cc).
Removing the Catheter
- To assist the doctor, inspect the chest X-ray for sign of catheter kinking or knotting
- Obtain the client’s baseline vital signs and note the ECG pattern
- Place the head end flat, the doctor will remove any sutures securing the catheter . If the introducers were removed, apply pressure to the site and check it frequently for signs of bleeding. Dress the site again, as necessary.
Special Consideration
- Advise the client to use caution when moving about in bed to avoid dislodging the catheter
- Never leave the balloon inflated because this may cause pulmonary infarction.
- To determine if the balloon is inflated, cheek the monitor for a wedge tracing, which indicates inflation
- Never inflate the balloon with more recommended air volume
- Be aware that the catheter may slip back into the right ventricle.
- Because the tip may irritate the ventricle, check the monitor for a right ventricle waveform to detect this problem promptly
- To minimize vascular trauma, make sure the balloon is inflated whenever the catheter is withdrawn from the pulmonary artery to the right ventricle or from the right to the right atrium.
Complications
Complications of PA catheter insertion include PA perforation, pulmonary infarction, catheter knotting, local or systemic infection, cardiac arrhythmias and heparin- induced thrombocytopenia.
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