16388312 swan ganz pulmonary artery pressure catheter

8/8/2019 16388312 Swan Ganz Pulmonary Artery Pressure Catheter

1/15

Pulmonary Artery

Pressure Monitoring

the most invasive of the

critical care monitoringcatheters

also known as a right heart

catheter, or a Swan-Ganzcatheter


2/15

#

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


3/15

#

Indications

When specific hemodynamic and intracardiacdata are required for diagnostic and treatment

purposes, a thermodilution PA catheter maybe inserted.

to evaluate patient response to treatment

can simultaneously assess several

hemodynamic parameters measure CO and to calculate additional

hemodynamic parameters


4/15

#

CONTRAIN

IDACT

IONS

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 assistdevice

Insertion during cardiopulmonary bypass


5/15

#


6/15

#

INVASIVE HEMODYNAMIC

MONITORING


7/15

#

Pulmonary Artery Catheters

110 cm in length

made of polyvinyl chloride used size is 7.5 or 8.0 Fr,


8/15

#


9/15

#

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 specialsyringe is connected

Infusion port [White] used for fluid infusion


10/15

#

Nursing Management

Factors that affect PA measurement

head-of-bed position

lateral body position relative to transducer height

placement

respiratory variationuse of positive end-expiratory pressure (PEEP).


11/15

#


12/15

#


13/15

#


14/15

#

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 ifIV sedation isanticipated 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 thetransducer is connected properly to the PAC.


15/15

#

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 tolumens 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 majorcomplication of pulmonary arterial catheterization. If the catheter is leftin 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 breathingpatient or during inspiration in a patient undergoing positive pressureventilation to prevent air embolism.

Apply pressure at the site for 1 to 2 minutes with the patient in flat orslight reverse Trendelenburg position to ensure hemostasis.

Do NOT withdraw the catheter against resistance.

16388312 swan ganz pulmonary artery pressure catheter

Documents