1 pulmonary artery pressure measurement issued may 2004
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Pulmonary Artery Pressure Pulmonary Artery Pressure MeasurementMeasurement
Issued May 2004Issued May 2004
Pulmonary Artery Pressure Measurement Alert2
Lecture Content
Patient Positioning
Identify Phelbostatic Axis
Leveling
Square Wave Test
Obtain PA Reading
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Patient Positioning
SupineHead of bed: 0-60°Angels 45º
30º
0º
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Leveling
Eliminates effects of hydrostatic forces on the observed hemodynamic pressures
Ensure air-fluid interface of the transducer is leveled before zeroing and/or obtaining pressure readings
Phlebostatic axis: Level of left atrium 4th ICS & ½ AP diameter Mark the chest with washable felt pen
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Intersection of the 4th ICS and ½ the anterior-posterior diameter of the chest
Identify Phlebostatic Axis
McHale DL, Carlson KK. AACN Procedure Manual for Critical Care 4th ed
WB Saunders: Philadelphia, Pa 2001 (479)With permission from Elsevier
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Used with permission of PACEP Collaborative
Mark location chest wall with washable felt pen
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Level Transducer System
Ensure air-fluid interfaceof the transducer is level to phelbostatic axis.
Used with permission of PACEP Collaborative
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Level Transducer System
Relevel the transducer with any change in the patient’s position
Referencing the system 1 cm above the left atrium decreases the pressure by 0.73 mm Hg
Referencing the system 1 cm below the left atrium increases the pressure by 0.73 mm Hg
Angels 45º 30º
0º
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Determines the ability of the transducer to correctly reflect pressures
Perform at the beginning of each shift
Square Wave Test
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Square Wave Test
Reprinted from Darovic GO. Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 2nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162Used with permission from Elsevier
Figure A: Expected square wave test
Figure C: Under damped
Figure B:Overdamped
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Under Damped System
Over responsive,
exaggerated, artificially
spiked waveform
SBP erroneously high;
DBP erroneously low
Causes: small air
bubbles, too long of
tubing, defective
transducer
Reprinted from Darovic GO. Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 2nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162Used with permission from Elsevier
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Over Damped System
Reprinted from Darovic GO. Hemodynamic Monitoring:Invasive and Noninvasive Clinical Application 2nd ed.
Philadelphia,Pa: WB Saunders Co;1995;161-162Used with permission from Elsevier
Sluggish, artificially rounded & blunted appearance
SBP erroneously low; DBP erroneously high
Causes: large air bubbles in system, compliant tubing, loose/open connections, low fluid level in flush bag
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PAP Documentation
Measure at end expiration
Measure pressures from a graphic tracing
Measure pulmonary capillary wedge pressure at end-expiration using the mean of the a wave a wave indicates atrial contraction and falls within the P – QRS interval of the corresponding ECG complex
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Respiratory Component
Changes in intrathoracic pressure
during respiration change PAP readings
Record and trend pressure readings at end expiration
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Used with permission of PACEP Collaborative
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Used with permission of PACEP Collaborative
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Used with permission of PACEP Collaborative
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Respiratory Variation
Spontaneous ventilation Mechanical ventilation
Aherns TS, Taylor LK. Hemodynamic Waveform Analysis. Philadelphia, Pa:
WB Saunders; 1992 27Used with permission from Elsevier
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Used with permission of PACEP Collaborative
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Used with permission of PACEP Collaborative
Pulmonary Artery Pressure Measurement Alert21
Used with permission of PACEP Collaborative
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Used with permission of PACEP Collaborative
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For more information or further assistance, please contact a clinical practice specialist with the AACN Practice Resource Network.
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