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• W2005199512 abstract "Q In routine hemodynamic monitoring with a pulmonary artery catheter in a stable critical care patient, how often should the pulmonary artery wedge pressure be assessed? Any information you could provide related to Swan-Ganz monitoring would be greatly appreciated.A Jan M. Headley, RN, BS, replies:Clinical use of the pulmonary artery catheter (PAC) may depend on the functionality of the catheter itself. All catheters can be used to obtain and monitor intracardiac and pulmonary artery pressures, provide intermittent or continuous thermodilution cardiac output values, and either to obtain intermittent mixed venous samples from the distal lumen or, if fiber optics are housed in the catheter, to monitor venous oxygen saturation continuously. These parameters are used in diagnosis, selection of therapy, and assessment of the response to interventions.The frequency with which hemodynamic values are obtained from the PAC is determined by the patient’s condition and any standards or protocols that the institution may have. No guidelines for the frequency of repeated measurements have been published; however, after therapeutic interventions, repeated measures are typically warranted.1,2In the past 2 decades, the reported use of PACs has decreased; however, the decline has not occurred in a uniform fashion. In a recent publication,3 the major area of decline occurred in nonsurgical intensive care units. Continued PAC use tends to be in surgical patients, those taking vasopressors, and those receiving mechanical ventilation. Potential rationales for the decline include decreased education or a knowledge deficit in obtaining accurate values and appropriate interpretation, the dearth of published evidence-based practice related to use of PACs, and potential complications when PACs are used.4One potential complication that may have led to less use of PACs is pulmonary artery rupture. This complication, although infrequent, can have catastrophic implications. The mean overall incidence of a pulmonary artery rupture is 0.01% to 0.47%; however, mortality has been reported at between 50% and 75% in patients taking anticoagulants.5 Perforation of the pulmonary artery may occur during insertion of the catheter or subsequent wedging. Patients who are elderly, have pulmonary hypertension, and/or are being treated with anticoagulants may present greater risk.2,5Pulmonary artery systolic and diastolic pressures are monitored is often part of a profile assessment and is used to indirectly reflect end-diastolic pressure in the left ventricle. This value is used to determine changes in filling pressure for the left ventricle. The normal relationship between the pulmonary artery diastolic pressure (PAD) and the occlusion or wedge pressure (PAOP) is 1 to 4 mm Hg, with the PAD being higher than the PAOP. Upon insertion of the PAC, make note of the relationship between the PAD and the PAOP. If within normal range, the PAD may be monitored to minimize the number of measurements of PAOP obtained subsequently.6,7Techniques to minimize the potential for pulmonary artery rupture include proper PAC placement on insertion by using 1.5 mL of air to inflate the balloon to obtain a wedge tracing. The pulmonary artery tracing should be checked carefully to ensure that spontaneous migration into a wedge position does not occur. This is noted by a pulmonary artery tracing that can become “overdamped” or a wedge tracing. In addition, if a wedge tracing is obtained subsequently, do not use more than 1.5 mL of air in the syringe; stop inflating as soon as a wedge tracing is observed regardless of the amount of air used. Note the amount of air required to obtain a clear wedge tracing. If the amount is less than 1.25 mL, the PAC may be positioned too far distally and repositioning may be necessary2,6,7 (see Figure).Standards based on the evidence for optimal pressure accuracy are available from the American Association of Critical-Care Nurses.8 More research needs to be done in the area of evidence-based practice for hemodynamic profile assessment. However, it may be more important to recognize that monitoring, no matter what type or frequency, improves care unless tied to a therapy that improves outcomes.1" @default.
• W2005199512 created "2016-06-24" @default.
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• W2005199512 date "2014-08-01" @default.
• W2005199512 modified "2023-10-18" @default.
• W2005199512 title "Pulmonary Artery Catheters and Assessment of Pulmonary Artery Wedge Pressure" @default.
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• W2005199512 doi "https://doi.org/10.4037/ccn2014271" @default.
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