Pulmonary artery catheter
Pulmonary artery catheter , still considered as the gold
standard for hemodynamic monitoring , was developed by Dr HJ Swan and Dr W Ganz
in 1970. With the availability of less invasive monitoring system and its
futility in decreasing mortality in critically-ill patients has limited its use
in modern ICU.
It is still being used in selected clinical conditions:
·
Complicated cardiac and noncardiac surgery
·
Situations where noninvasive techniques fail to
give clue to hemodynamic compromise
·
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Diagnosis of intracardiac shunts
·
Before heart-lung transplant.
What all parameters you can measure?
1.
Pressure : right atrial pressure, right
ventricular pressure, pulmonary artery pressure, pulmonary artery occlusion
pressure (indirectly reflecting LA pressure) can be measured directly.
2.
Strpke volume and cardiac output can be measured
– intermittently or semi-continously.
3.
SVR and PVR can be derived.
4.
Mixed venous oxygen saturation (SVO2)- either
intermittently or continuously.
5.
Change in oxygen saturation in different
chambers of heart to diagnose shunt.
Contraindications to PA Catheter
1.
Contraindications to central venous access.
2.
Left bundle branch block as it can be
complicated with complete AV block.
3.
Mechanical tricuspid or pulmonary valves.
Risks involved
·
Comlications of central venous access.
·
Mechanical injury to cardiac structures.
·
Pulmonary artery rupture and pulmonary
infarction- more common if balloon remains inflated for more than 15 seconds.
·
Arrhythmias including life-threatening
ventricular tachycardias and complete AV block.
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·
Colling of catheter in the RA (more common in
tricuspid regurgitation) or right ventricle (dilated RV or low output state).
Role of nurses :
1.
To assist the physicians during insertion of
invasive devices for hemodynamic monitoring. Nurse need to ensure that strict
aseptic precautions are followed during insertion.
2.
Setting up the monitoring system including
leveling and zeroing.
3.
Maintenance of devices- following infection
control practices, ensuring patency of
the device, periodic dressing changes.
4.
Ensuring the accuracy of the data obtained.
5.
Interpreting the data at the bedside and
alarming the physician about any abnormal data.
6.
Ensuring that invasive lines are not being kept
for longer than required.
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