What is a pulmonary artery catheter?
Pulmonary artery catheters (PAC) are balloon-tipped catheters used for intravenous hemodynamic monitoring.
A series of ports along the length of the catheter can be used to assess distinct measurements within the cardiac and vascular structures in which they sit.
PAC use has been declining in favor of less invasive echocardiography techniques in the assessment of many critical conditions; however, the PAC continues to be an excellent tool for assessing pulmonary hypertension, cardiogenic shock, and unexplained dyspnea.
List of indications:
- Diagnosis or evaluation of pulmonary hypertension
- Assessment of vascular resistance
- Determination of etiology in cases of shock
- Assessment of volume status in severe shock
- Evaluation of pericardial illnesses such as cardiac tamponade or constrictive pericarditis
- Assessment of right-sided valvular disease or congenital heart disease
- Evaluation of intracardiac shunts
Pulmonary artery catheter placement
The catheter is inserted through a central vein, jugular, or subclavian vein, as the femoral vein is usually avoided. It is then advanced through the right side of the heart to rest in the pulmonary artery (PA).
Pulmonary artery catheter waveforms and monitoring
A variety of measurements are derived from waveforms generated by the catheter, blood samples drawn for the catheter ports, and a temperature sensor in the case of core temperature measurement.
Monitoring parameters
- Cardiac output (CO)
- Pulmonary artery pressure (PAP)
- Mixed venous oxygenation (SvO2)
- Pulmonary artery wedge pressure (PAWP): 3 “bumps” in waveform called waves
- Central venous pressure (CVP): shown as 2 “bumps” in waveform
- Core temperature
Nursing care tasks:
- Educate clients and family about the purpose of the pulmonary artery catheter, as well as risks, benefits and possible complications.
- Ensure that informed consent has been given and documented.
- Organize necessary supplies and equipment; assist with PAC insertion as needed.
- Maintain PAC set up, coordinate dressing changes as ordered, ensure asepsis for infection prevention.
- Monitor PAC waveforms continuously; document the indicated parameters as ordered.
- Notify the provider of any change in client status, or if PAC is displaced or in need of adjustment.
Pulmonary artery catheter removal
Procedure
Start with reviewing the catheter removal order. Ensure that any medications previously administered through the PAC have been discontinued or relocated to another appropriate infusion site. Gather and organize supplies, and explain the procedure to the client.
- Assist client into supine position.
- Ensure that balloon is deflated.
- Turn stopcocks off to client, discard all intravenous
solutions or flushes. - Perform hand hygiene.
- Don mask and face shield or goggles.
- Remove old dressing and unlock sheath from
introducer. - Instruct client to turn face away from PAC site,
take a deep breath and hold it, or hum. - Secure introducer site with one hand and gently
withdraw PA catheter with the other hand, while
monitoring for arrhythmias. - Apply and lock introducer cap as soon as catheter
is removed. - Inspect catheter after removal to be sure it is intact.
- Clean insertion site with a chlorhexidine wand.
- Place new chlorhexidine dressing over introducer site.
After removal, monitor for signs of bleeding or infection at the insertion site.
Free download: PAC removal and complications
Quick summary of the steps for pulmonary artery catheter removal and risks
Risks and potential complications during PAC removal
- Valvular injury: If the balloon at the catheter tip is inflated during catheter removal, it may cause damage as it passes through the cardiac valves. Ensure that the balloon is fully deflated before initiating catheter removal.
- Air embolism: If the client breathes in during PAC removal, an air embolism may occur. Prevent this complication by educating the client and involving them in the procedure. Instructing the client to hold their breath or hum avoids an in-breathe during catheter removal.
- Arrhythmias: The catheter tip may irritate the cardiac muscle, leading to arrhythmias during the catheter removal process. Though often transient, monitor the clients cardiac rhythm carefully and be ready to intervene if needed.
- Infection: Maintain sterile technique during removal. Monitor carefully for signs of infection.
