PULMONARY ARTERY

CATHETERIZATION
(Swan-Ganz)
 PULMONARY ARTERY
CATHETERIZATION
I. Indications:
a. Diagnosis and evaluation of heart
disease.
b. Evaluates patient’s response to
treatment.
c. Simultaneous assessment of several
hemodynamic parameters.
 PULMONARY ARTERY
CATHETERIZATION

 Pulmonary Artery Pressure (PAP)

 Pulmonary Capillary Wedge Pressure
(PCWP)
 Cardiac Output / Cardiac Index (CO / CI)
 Mixed Venous Oxygen Saturation (SVO2)
 PULMONARY ARTERY
CATHETERIZATION
II. PA Catheters
 4 Lumen catheters

a. Proximal lumen - IV infusion, (blue)

CVP
measurement, venous
blood samples, injection of
fluids.
 PULMONARY ARTERY
CATHETERIZATION
II. PA Catheters
 4 Lumen catheters

b. Distal lumen - PA pressures

(yellow)
c. Balloon inflation lumen (red)
d. Thermistor lumen - cardiac
output
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CATHETERIZATION

II. PA Catheters

Others: Multi-lumen PA catheters

• 5 lumen - fiberoptic
lumen
• 7 lumen - pacemaker lumen;
injectate lumen
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CATHETERIZATION
III. Sites of insertion
 Brachial Vein

• Subclavian Vein
 Femoral Vein
 Jugular Vein
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CATHETERIZATION
IV. Things to prepare:
 adhesive tapes
 infusion set tubing
 amplifier/ recorder
 multiple lumen catheter
 OS 4x4
 betadine
 pressure bag
 cordis sheath
 Seldinger/Cook’s
 critiflo/ intraflo
needle
 D5NSS w/ Heparin  3-way stopcock
 D5NSS (plain)  10 cc syringes (2)
 gloves  transducer
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CATHETERIZATION
V. Nursing Responsibilities
A. Before Insertion

1. Explain procedure

2. Informed written consent.

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CATHETERIZATION
V. Nursing Responsibilities
A. Before Insertion

3. Assemble equipment / supplies

4. Measure BP, PR and RR;

Temperature (CO)
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CATHETERIZATION
V. Nursing Responsibilities
A. Before Insertion

5. Attach to ECG monitor.

6. Position: Supine or
Trendelenberg
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CATHETERIZATION
V. Nursing Responsibilities
B. During Insertion

1. Monitor the patient’s ECG.

2. Stay with the patient.

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CATHETERIZATION
C. After insertion

1. Observe for signs of

pneumothorax.

2. Continuous monitoring of chest

sounds / ECG
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CATHETERIZATION
 Right Atrial Pressure
(RAP)
- 2 - 6 mmHg
 Increased Pressure
 volume overload; Right

heart failure; Pulmonary

Hpn
 Decreased Pressure
 hypovolemia
 PULMONARY ARTERY
CATHETERIZATION
 Right Ventricular Pressure
(RVP)
15 - 25 mmHg
2 - 8 mmHg

 Increased Pressure
 Pulmonary diseases;

Septal Defects
 PULMONARY ARTERY
CATHETERIZATION
 Pulmonary Artery Pressure
15 - 25 mmHg
8 - 15 mmHg

 Increased Pressure
 left heart failure

 Pulmonary edema/embolism
 PULMONARY ARTERY
CATHETERIZATION
 Pulmonary Capillary Wedge
Pressure ( PCWP)
4 - 12 mmHg (mean)

 Increased Pressure
 Left Heart Failure

 Pericardial Tamponade

 Reduced CO2
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CATHETERIZATION
C. After insertion

3. Check for signs of decreased

circulation.

4. Check for signs of infection.

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CATHETERIZATION
C. After insertion
5. Document all pressure
readings
including patient’s position.
6. Troubleshoot hemodynamic
monitoring CAUSES
PROBLEM
problems
TROUBLESHOOTING
a. Damping of  Air bubbles / blood / - complete flushing
waveform / No tracing blood clots along the before insertion
line
 Loose connections / - aspirate / never flush
disconnections air / clot
 Kinked catheter - check patency of
 Incorrect position of tubings.
stopcocks
 Improper adjustment - adjust sensitivity
of sensitivity control - Recalibrate
6. Troubleshoot hemodynamic
monitoring problems
PROBLEM CAUSES TROUBLESHOOTING

b. Failure to wedge  Balloon rupture - NEVER inflate

balloon
- Indicate balloon is
ruptured. “ No
Wedging”
6. Troubleshoot hemodynamic

monitoringCAUSES
PROBLEM problems
TROUBLESHOOTING

c. Permanent  Balloon inadvertently - ensure catheter

Wedging inflated deflation
 Catheter migration - turn patient from side
to side
- deep breathing and
voluntary coughing
- refer to doctor
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CATHETERIZATION
C. After insertion

7. Administer oxygen therapy and

medications as ordered.
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CATHETERIZATION
8. Watch out for complications.
1. Dysrrhythmias - irritation of
heart muscles
2. Local infection - irritation; poor
sterile
techniques
3. Pulmonary Artery Perforation
- over-inflation
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CATHETERIZATION
8. Watch out for complications.
4. Pulmonary Infarction
- frequent prolonged wedging
- thrombus formation
5. Pulmonary Embolism
- over / frequent inflation; air
embolism
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CATHETERIZATION
8. Watch out for complications.

6. Endocarditis - mechanical irritation;

bacterial growth
7. Knotting of Catheter - continuous
manipulation
8. Pneumothorax - insertion techniques
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CATHETERIZATION
VI. Responsibilities during removal of PA
line

1. Lidocaine bolus and defibrillation at

bedside
2. Obtain vital signs
3. Assess circulation of extremities
4. Deflate balloon
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CATHETERIZATION
VI. Responsibilities during removal of PA
line

5. Monitor for dysrrhythmias

6. Apply firm pressure until bleeding stops.
7. Apply betadine and dressing

NOTE: PA Catheter to stay for 72 hours.