1. 1 Pulmonary Artery Pressure Measurement Issued May 2004

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

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

4. 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  4 th ICS & ½ AP diameter  Mark the chest with washable felt pen

5. Pulmonary Artery Pressure Measurement Alert 5 Intersection of the 4 th ICS and ½ the anterior-posterior diameter of the chest Identify Phlebostatic Axis McHale DL, Carlson KK. AACN Procedure Manual for Critical Care 4 th ed WB Saunders: Philadelphia, Pa 2001 (479) With permission from Elsevier

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

7. 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

8. 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

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

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

11. 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 2 nd ed. Philadelphia,Pa: WB Saunders Co;1995;161-162 Used with permission from Elsevier

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

13. 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

14. 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

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

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

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

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

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

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

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

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

23. Pulmonary Artery Pressure Measurement Alert 23 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