![Page 1: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/1.jpg)
1
Pulmonary Artery Pressure Pulmonary Artery Pressure MeasurementMeasurement
Issued May 2004Issued May 2004
![Page 2: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/2.jpg)
Pulmonary Artery Pressure Measurement Alert2
Lecture Content
Patient Positioning
Identify Phelbostatic Axis
Leveling
Square Wave Test
Obtain PA Reading
![Page 3: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/3.jpg)
Pulmonary Artery Pressure Measurement Alert3
Patient Positioning
SupineHead of bed: 0-60°Angels 45º
30º
0º
![Page 4: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/4.jpg)
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
![Page 5: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/5.jpg)
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
![Page 6: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/6.jpg)
Pulmonary Artery Pressure Measurement Alert6
Used with permission of PACEP Collaborative
Mark location chest wall with washable felt pen
![Page 7: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/7.jpg)
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
![Page 8: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/8.jpg)
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
![Page 9: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/9.jpg)
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
![Page 10: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/10.jpg)
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
![Page 11: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/11.jpg)
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
![Page 12: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/12.jpg)
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
![Page 13: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/13.jpg)
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
![Page 14: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/14.jpg)
Pulmonary Artery Pressure Measurement Alert14
Respiratory Component
Changes in intrathoracic pressure
during respiration change PAP readings
Record and trend pressure readings at end expiration
![Page 15: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/15.jpg)
Pulmonary Artery Pressure Measurement Alert15
Used with permission of PACEP Collaborative
![Page 16: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/16.jpg)
Pulmonary Artery Pressure Measurement Alert16
Used with permission of PACEP Collaborative
![Page 17: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/17.jpg)
Pulmonary Artery Pressure Measurement Alert17
Used with permission of PACEP Collaborative
![Page 18: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/18.jpg)
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
![Page 19: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/19.jpg)
Pulmonary Artery Pressure Measurement Alert19
Used with permission of PACEP Collaborative
![Page 20: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/20.jpg)
Pulmonary Artery Pressure Measurement Alert20
Used with permission of PACEP Collaborative
![Page 21: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/21.jpg)
Pulmonary Artery Pressure Measurement Alert21
Used with permission of PACEP Collaborative
![Page 22: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/22.jpg)
Pulmonary Artery Pressure Measurement Alert22
Used with permission of PACEP Collaborative
![Page 23: 1 Pulmonary Artery Pressure Measurement Issued May 2004](https://reader036.vdocument.in/reader036/viewer/2022062620/551b74c9550346d6338b5027/html5/thumbnails/23.jpg)
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:[email protected]
Phone:
(800) 394-5995, x217