Pulmonary Artery
Pressure Monitoring
the most invasive of the
critical care monitoring
catheters
also known as a right heart
catheter, or a Swan-Ganz
catheter
Indications
– Diagnostic
• Diagnosis of shock states
• Differentiation of high- versus low-pressure pulmonary edema
• Diagnosis of primary pulmonary hypertension (PPH)
• Diagnosis of valvular disease, intracardiac shunts, cardiac
tamponade, and pulmonary embolus (PE)
• Monitoring and management of complicated AMI
• Assessing hemodynamic response to therapies
• Management of multiorgan system failure and/or severe burns
• Management of hemodynamic instability after cardiac surgery
• Assessment of response to treatment in patients with PPH
– Therapeutic - Aspiration of air emboli
#
Indications
• When specific hemodynamic and intracardiac
data are required for diagnostic and treatment
purposes, a thermodilution PA catheter may
be inserted.
• to evaluate patient response to treatment
• can simultaneously assess several
hemodynamic parameters
• measure CO and to calculate additional
hemodynamic parameters
#
CONTRAINIDACTIONS
• Latex allergy
• Previous pneumonectomy
• A patient at risk of severe arrhythmias.
Anticoagulation
• Patient or surrogate decision-maker refusal
• Infection at the insertion site
• The presence of a right ventricular assist
device
• Insertion during cardiopulmonary bypass
#
#
INVASIVE HEMODYNAMIC
MONITORING
#
Pulmonary Artery Catheters
• 110 cm in length
• made of polyvinyl chloride
• used size is 7.5 or 8.0 Fr,
#
#
Components of Swan-Ganz
• Proximal port – [Blue] used to measure
central venous pressure/RAP and injectate
port for measurement of cardiac output
• Distal port – [Yellow] used to measure
pulmonary artery pressure
• Balloon port – [Red] used to determine
pulmonary wedge pressure;1.5 special
syringe is connected
• Infusion port – [White] used for fluid infusion
#
Nursing Management
• Factors that affect PA measurement
head-of-bed position
lateral body position relative to transducer height
placement
respiratory variation
use of positive end-expiratory pressure (PEEP).
#
#
#
#
• Place the patient in a supine position.
• Slight Trendelenburg position may increase venous pressure,
facilitating cannulation of a central vein.
• Place standard patient monitors, including ECG, blood pressure
cuff, and pulse oximeter.
• When possible, establish peripheral intravenous access,
connected to IV tubing and IV fluid solution.
• Consider IV sedation for patient comfort.
• Apply oxygen via nasal cannula or mask if IV sedation is
anticipated or used.
• Perform a sterile prep with chlorhexidine
• Wash hands and wear mask, sterile gown, and gloves.
• Drape the entire patient from head to toe,
• Place an introducer sheath into a large central vein.
• Check the PAC to ensure all lumens flush easily and the
transducer is connected properly to the PAC.
#
POST-PROCEDURE CARE
• Flush lumens in catheter with saline.
• Obtain chest radiograph to confirm position of catheter and to rule out
pneumothorax.
• Use sterile technique when injecting drugs or connecting tubing to
lumens of catheter.
• Dressings should be changed routinely with use of sterile prep.
• Examine the insertion site for signs of infection daily.
• Catheter-related infection of the pulmonary catheter is a potential major
complication of pulmonary arterial catheterization. If the catheter is left
in place for more than 72 hours, the risk for infection rises significantly.
• For catheter removal, place the patient in slight Trendelenburg position.
Remove the catheter during exhalation in a spontaneously breathing
patient or during inspiration in a patient undergoing positive pressure
ventilation to prevent air embolism.
• Apply pressure at the site for 1 to 2 minutes with the patient in flat or
slight reverse Trendelenburg position to ensure hemostasis.
• Do NOT withdraw the catheter against resistance.
