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Pulmonary Artery Pressure Measurement

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 Measurement

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  1. Pulmonary Artery Pressure Measurement Issued May 2004 Pulmonary Artery Pressure Measurement Alert

  2. Lecture Content • Patient Positioning • Identify Phelbostatic Axis • Leveling • Square Wave Test • Obtain PA Reading Pulmonary Artery Pressure Measurement Alert

  3. Supine Head of bed: 0-60° Patient Positioning Angels 45º 30º 0º Pulmonary Artery Pressure Measurement Alert

  4. 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 Alert

  5. Identify Phlebostatic Axis Intersection of the 4th ICS and ½ the anterior-posterior diameter of the chest 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 Alert

  6. Mark location chest wall with washable felt pen Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  7. Level Transducer System Ensure air-fluid interface of the transducer is level to phelbostatic axis. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  8. 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 Alert

  9. Square Wave Test • Determines the ability of the transducer to correctly reflect pressures • Perform at the beginning of each shift Pulmonary Artery Pressure Measurement Alert

  10. Square Wave Test Figure A: Expected square wave test Figure B: Over damped Figure C: Under damped Reprinted from Darovic GO. Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 2nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162 Used with permission from Elsevier Pulmonary Artery Pressure Measurement Alert

  11. 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;161-162 Used with permission from Elsevier Pulmonary Artery Pressure Measurement Alert

  12. Over 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 bag Reprinted from Darovic GO. Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 2nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162 Used with permission from Elsevier Pulmonary Artery Pressure Measurement Alert

  13. 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 Alert

  14. Respiratory Component • Changes in intrathoracic pressure during respiration change PAP readings • Record and trend pressure readings at end expiration Pulmonary Artery Pressure Measurement Alert

  15. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  16. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  17. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  18. Respiratory Variation Spontaneous ventilation Mechanical ventilation Aherns TS, Taylor LK. Hemodynamic Waveform Analysis. Philadelphia, Pa: WB Saunders; 1992 27 Used with permission from Elsevier Pulmonary Artery Pressure Measurement Alert

  19. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  20. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  21. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  22. Used with permission of PACEP Collaborative Pulmonary Artery Pressure Measurement Alert

  23. Need Further Assistance? For more information or further assistance, please contact a clinical practice specialist with the AACN Practice Resource Network. Email: practice@aacn.org Phone: (800) 394-5995, x217 Pulmonary Artery Pressure Measurement Alert

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