Pulmonary artery catheter. importance of pulmonary artery catheter.

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 non cardiac surgery

·         Situations where noninvasive techniques fail to give clue to hemodynamic compromise

·         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.      Stroke volume and cardiac output can be measured – intermittently or semi- continuously.

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

·         Complications 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 tachycardia  and complete AV block.

·         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.