1 pulmonary artery pressure measurement issued may 2004

1

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

Pulmonary Artery Pressure Measurement Alert3

Patient Positioning

SupineHead of bed: 0-60°Angels 45º

30º

0º

Pulmonary Artery Pressure Measurement Alert4

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

Pulmonary Artery Pressure Measurement Alert5

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

Pulmonary Artery Pressure Measurement Alert6

Used with permission of PACEP Collaborative

Mark location chest wall with washable felt pen

Pulmonary Artery Pressure Measurement Alert7

Level Transducer System

Ensure air-fluid interfaceof the transducer is level to phelbostatic axis.

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert8

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

Pulmonary Artery Pressure Measurement Alert9

Determines the ability of the transducer to correctly reflect pressures

Perform at the beginning of each shift

Square Wave Test

Pulmonary Artery Pressure Measurement Alert10

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

Pulmonary Artery Pressure Measurement Alert11

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

Pulmonary Artery Pressure Measurement Alert12

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

Pulmonary Artery Pressure Measurement Alert13

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

Pulmonary Artery Pressure Measurement Alert14

Respiratory Component

Changes in intrathoracic pressure

during respiration change PAP readings

Record and trend pressure readings at end expiration

Pulmonary Artery Pressure Measurement Alert15

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert16

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert17

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert18

Respiratory Variation

Spontaneous ventilation Mechanical ventilation

Aherns TS, Taylor LK. Hemodynamic Waveform Analysis. Philadelphia, Pa:

WB Saunders; 1992 27Used with permission from Elsevier

Pulmonary Artery Pressure Measurement Alert19

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert20

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert21

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert22

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert23

For more information or further assistance, please contact a clinical practice specialist with the AACN Practice Resource Network.

Need Further Assistance?

Email:practice@aacn.org

Phone:

(800) 394-5995, x217