Nursing Care of Pulmonary Artery CathetersJulie N. Walton, Purdue University School of Nursing

What is a Pulmonary Artery Catheter?

Risks & Complications

Obtaining Wedge Pressure

Evidence Based Practice

Hemodynamic Monitoring

References

Obtaining Cardiac Output

PACs consist of special tubing that goes through the right heart and rests in the pulmonary artery. This placement gives the qualified professional the ability to measure many parameters of hemodynamic monitoring including heart function and blood flow.

Insertion: Minor

• Hematoma

• Infection

• Ventricular arrhythmia

Insertion: Major

• Ventricular tachycardia

• Pulmonary artery rupture

Data

• Misinterpretation of waveforms

• Mismanagement of patient

Hemodynamic Values

Measurement Range*

Right Atrial Pressure (RAP) 2-12 mm Hg

Right Ventricular Pressure (RVP) Systolic: 20-30 mm HgDiastolic: 0-5 mm Hg

Pulmonary Artery Pressure (PAP) Systolic: 15-25 mm HgDiastolic: 8-10 mm Hg

Pulmonary Capillary WedgePressure (PCWP)

8-15 mm Hg

Cardiac Output (CO) 4-8 L/min

Community Health Network Policy• Place patient in supine position with head

of bed 30-45 degrees & level the transducer to the phlebostatic axis

• Unlock balloon port, remove syringe, fill syringe with 1.5 ml of air & replace syringe

• Turn on monitor recorder to obtain strip if desired

• Inject air slowly while watching pulmonary artery waveform

PACs can be extremely useful in the critical patient. Constant monitoring of blood pressure can provide the Registered Nurse or other health professional with knowledge of the stability of the patient.

• Maintain balloon inflation for 8-15 seconds (2-3 respiratory cycles)• Obtain Wedge Pressure (PCWP) from monitor, then slowly allow

balloon to deflate passively. Remove syringe, lock the port, expel air from syringe & replace syringe. Flush the line.

Current evidenced base practice research in regards to PACs is directed at whether or not PACs lead to an increase in mortality. Many studies support the idea that PACs lead to increased mortality, but many other studies supported the opposite finding. Multiple studies showed that PACs may be associated with complications including death, but still may be necessary for patients to have this type of monitoring during the course of treatment. More research in regards to the necessity of PACs verses the rate of complications needs to be completed.

Chatterjee, K. (2009). Historical Perspectives in Cardiology, The Swan-Ganz Catheters: Past, Present, and Future. Circulation American Heart Association. Vol. 119,147-152. http://circ.ahajournals.org/content/119/1/147.full

Cisar, N. S., Caruso, E. M., Hess, G. M., & Whitman, J. L. (2010). Changing the Environment of Care for Patients With a Pulmonary Artery Catheter. Critical Care Nurse. Vol. 30, No. 2, 34-44. http://ccn.aacnjournals.org/content/30/2/34.full

Community Health Network (2003). Competency Verification Checklist Hemodynamic Monitoring. Indianapolis, IN: Hemodynamic Monitoring Task Force

Community Health Network (2013). Hemodynamic Monitoring with Pulmonary Artery Catheter. Corporate Nursing Policy and Procedures. Indianapolis, IN.

Dugdale, D. C., Chen, M. A., & Zieve, D. (2012). Swan-Ganz: Right Heart Catheterization. MedlinePlus. Retrieved from: http://www.nlm.nih.gov/medlineplus/ency/article/003870.htm

Muck, K. & Polinsky S. (2010). Pulmonary Artery Catheter & Hemodynamic Values. Rn.com Retrieved from: http://www.austincc.edu/nursmods/online/online_lev4/rnsg_2432/documents/ PulmonaryArteryCatheter.pdf

Polaski & Tatro (1996). Swan-Ganz Catheters. Medical Dictionary. Retrieved from: http://medical-dictionary.thefreedictionary.com/Swan-Ganz+catheter

Hemodynamic values are important indicators of the patient’s current state. Understanding and knowing waveforms (Refer to the diagram at right) and measurement ranges (below) are essential parts of PAC nursing care.

Set Up

• Connect All CO Cable Components, Spike IV Solution Bag and Prime CO tubing to Gravity & Connect syringe to stopcock at proximal port

• Connect in line temperature probe to syringe, Verify PAC parameters on Monitor & Check PAC position by waveform analysis & verify deflation of balloon

Perform

• Open Clamp on CO tubing & fill syringe with the proper amount of solution (3-10 ml).

• Inject Solution smoothly within 2-4 seconds, collecting at least 3 consecutive values. Discard values that are beyond 10% in variation.

• Calculate hemodynamic profile per specific equipment guidelines. Tubing may remain connected or disconnected from proximal port stopcock.

*Many sources show different ranges—be sure to follow your patient’s specific ordered parameters