Pulmonary artery catheter

Monitoring the patient in shock requires vigilance on the part of the nurse The patient s heart rate, blood pressure, and ECG are monitored continuously. The urinary output is measured often (usually hourly), and an accurate intake and output is taken. Monitoring of central venous pressure via a central venous catheter will provide an estimation of the patient s fluid status. Sometimes additional hemodynamic monitoring is necessary with a pulmonary artery catheter. The use of a pulmonary artery catheter allows the nurse to monitor a number of parameters, such as cardiac output and peripheral vascular resistance The nurse adjusts therapy according to the primary health care provider s instructions. 

Utilize a central line +/- pulmonary artery catheter ° 10 mg/kg IV over 30 min followed by 5 mg/kg/h continuous IV infusion for 3 h (total loading dose is 25 mg/kg)... 

Invasive hemodynamic monitoring in patients with HF entails placement of a right heart or pulmonary artery catheter (PAC). The catheter is inserted percutaneously through a central vein and advanced through the right side of the heart to the... 

Pulmonary artery catheter measurements decreased CO, decreased SV, increased SVR, low PAOP (pulmonary artery occlusion pressure)... 

Pulmonary artery catheter An invasive device used to measure hemodynamic parameters directly, including cardiac output and pulmonary artery occlusion pressure calculated parameters include stroke volume and systemic vascular resistance. 

Continuous hemodynamic monitoring is essential during all phases of hypothermia. Cardiac monitoring is necessary because of the increased risk of arrhythmias. Cardiac output is decreased 5% for every 1°C of body temperature reduction. This is thought to be secondary to bradycardia, which has been shown to occur with hypothermia (3). A pulmonary artery catheter may be placed if there is any question of hemodynamic instability. Arterial catheters are used for continuous blood pressure measurement, as well as for access to arterial blood for blood gas and electrolyte analysis. 

More specific treatment to combat cardiotoxic effects is usually necessary in only a minority of instances in the series reported above (40), five patients (14%) had marked hypotension. Initial low left ventricular filling pressures were corrected within 3 hours by infusion of isotonic saline. Systemic hypotension persisted and was corrected by infusion of sympathomimetic amines. Routine insertion of a pulmonary artery catheter, with continuous monitoring of blood gases, pulmonary arterial pressure, left atrial wedge pressure, and cardiac output have been recommended (40). Volume expansion is suggested for low left atrial pressure,... 

Ikentice D, Ahrens T. Controversies in the use of the pulmonary artery catheter. J Cardiovasc Nurs 2001 15 1-5. 

Part of the concern regarding pulmonary artery catheterization relates to interpretation of its results by inexperienced practitioners. Smdies in both Europe and the United States found that one of two physicians incorrectly interpreted a tracing from a pulmonary artery catheter. This could explain some of the results of smdies finding no benefits to pulmonary artery catheterization or, in some cases, worse outcomes in the pulmonary artery catheterization group by actions taken as a result of inaccurate measurements or misinterpretation of information obtained from the monitoring process. 

Complications related to pulmonary artery catheter insertion, maintenance, and removal include damage to vessels and organs during insertion, arrhythmias, infections, and thromboembolic damage. To avoid the complications associated with pulmonary artery catheterization, other less invasive tools were developed to obtain similar information. For example, cardiac output determinations have been made by Doppler, bioimpedance, dye, and ionic dilution techniques, although such measurements would not provide other data that are obtained routinely with pulmonary artery catheters (e.g., left-sided heart-filling pressure). Additionally, advances in... 

Ivanov R, Allen J, Calvin JE. The incidence of major morbidity in critically ill patients managed with pulmonary artery catheters A meta-analysis. Crit Care Med 2000 28 615-619. 

Sandham JD, Hull RD, Brant RF, et al. A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients. N Engl J Med 2003 348 5-14. 

Pulmonary artery catheter to measure pulmonary wedge pressure, which should be normal (<18 mm Hg). 

If the above measures are unsuccessful, insert a central venous pressure (CVP) monitor or pulmonary artery catheter to detenaine whether further fluids are needed and to measure the cardiac output (CO) and calculate the systemic vascular resistance (SVR) as follows ... 

Finally, two examples of the human errors that belong to the workload distribution/distraction avoidance classification are the resident staff reading the technical manual, resulting in the patient not being adequately relaxed, and the consultant being distracted from making a decision to place a pulmonary artery catheter by problems identified by another operating facility. 

A common cause of death in Western Europe is chronic heart failure. Measures for its severity are hemodynamic parameters, including stroke volume (SV). Until now, the gold standard for measuring these parameters is the thermodilution technique using pulmonary artery catheters. However, the risks of estimating cardiac output via catheters include infections, sepsis and arrhythmias, as well as increased morbidity and mortality. An alternative technique to assess SV easily and cost-effectively is the use of impedance cardiography (ICG). 

Bose, R., Choi, J.W. Successful percutaneous retrieval of methyl methacrylate orthopedic cement embolism from the pulmonary artery. Cathet. Cardiovasc. Interv. 76,198-201 (2010)... 

Irritation of ventricles by pacemaker electrodes or a pulmonary artery catheter. 

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