Pulmonary Artery Pressure Measurement

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Pulmonary Artery Pressure Measurement. Issued May 2004. Lecture Content. Patient Positioning Identify Phelbostatic Axis Leveling Square Wave Test Obtain PA Reading. Supine Head of bed: 0-60 °. Patient Positioning. Angels 45º 30º 0º. Leveling.
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Pulmonary Artery Pressure MeasurementIssued May 2004Lecture Content
  • Patient Positioning
  • Identify Phelbostatic Axis
  • Leveling
  • Square Wave Test
  • Obtain PA Reading
  • Pulmonary Artery Pressure Measurement AlertSupineHead of bed: 0-60°Patient PositioningAngels 45º 30º 0ºPulmonary Artery Pressure Measurement AlertLeveling
  • 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 AlertIdentify Phlebostatic AxisIntersection of the 4th ICS and ½ the anterior-posterior diameter of the chestMcHale DL, Carlson KK. AACN Procedure Manual for Critical Care 4thedWB Saunders: Philadelphia, Pa 2001 (479)With permission from ElsevierPulmonary Artery Pressure Measurement AlertMark location chest wall with washable felt penUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertLevel Transducer SystemEnsure air-fluid interfaceof the transducer is level to phelbostatic axis.Used with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertLevel 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 0ºPulmonary Artery Pressure Measurement AlertSquare Wave Test
  • Determines the ability of the
  • transducer to correctly reflect pressures
  • Perform at the beginning of
  • each shiftPulmonary Artery Pressure Measurement AlertSquare Wave TestFigure A: Expected square wave testFigure B:OverdampedFigure C: Under dampedReprinted from Darovic GO. Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 2nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162Used with permission from ElsevierPulmonary Artery Pressure Measurement AlertUnder 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 ElsevierPulmonary Artery Pressure Measurement AlertOver Damped System
  • 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 bagReprinted from Darovic GO. Hemodynamic Monitoring:Invasive and Noninvasive Clinical Application 2nd ed.Philadelphia,Pa: WB Saunders Co;1995;161-162Used with permission from ElsevierPulmonary Artery Pressure Measurement AlertPAP 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 complexPulmonary Artery Pressure Measurement AlertRespiratory Component
  • Changes in intrathoracic pressure
  • during respiration change PAP readings
  • Record and trend pressure readings at end expiration
  • Pulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertRespiratory VariationSpontaneous ventilationMechanical ventilationAherns TS, Taylor LK. Hemodynamic Waveform Analysis. Philadelphia, Pa: WB Saunders; 1992 27Used with permission from ElsevierPulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertUsed with permission of PACEP CollaborativePulmonary Artery Pressure Measurement AlertNeed Further Assistance?For more information or further assistance, please contact a clinical practice specialist with the AACN Practice Resource Network.Email:practice@aacn.orgPhone:(800) 394-5995, x217Pulmonary Artery Pressure Measurement Alert
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