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Pulmonary Artery Pressure Measurement

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. Patient Positioning. SupineHead of bed: 0-60. . . Angels 45 30

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Pulmonary Artery Pressure Measurement

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    1. Pulmonary Artery Pressure Measurement Alert 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 Presentation relies on research based guidelines from national groups, governmental agencies or expert groups. Presentation relies on research based guidelines from national groups, governmental agencies or expert groups.

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

    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 4th ICS & ˝ AP diameter Mark the chest with washable felt pen

    5. Pulmonary Artery Pressure Measurement Alert 5 Identify Phlebostatic Axis

    6. Pulmonary Artery Pressure Measurement Alert 6

    7. Pulmonary Artery Pressure Measurement Alert 7 Level Transducer System

    8. Pulmonary Artery Pressure Measurement Alert 8 Level Transducer System

    9. Pulmonary Artery Pressure Measurement Alert 9

    10. Pulmonary Artery Pressure Measurement Alert 10 Square Wave Test

    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

    12. Pulmonary Artery Pressure Measurement Alert 12 Over Damped System

    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 Early VAP (within 96 hours) is associated with non-multi-antibiotic-resistant organisms: E coli Klebsiella Proteus Streptococcus pneumoniae Hemophylus influenza Oxacillin sensitive Staphlococcus aureus Late VAP associated with antibiotic-resistant organisms: Pseudomonas aeruginosa Oxacillin resistance Staphaerius and Acinetobacter Early VAP (within 96 hours) is associated with non-multi-antibiotic-resistant organisms: E coli Klebsiella Proteus Streptococcus pneumoniae Hemophylus influenza Oxacillin sensitive Staphlococcus aureus Late VAP associated with antibiotic-resistant organisms: Pseudomonas aeruginosa Oxacillin resistance Staphaerius and Acinetobacter

    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 All these CDC recommendations are at level IA: Use a continuous subglottic suction ET tube for all intubations expected to be > 24 hours. Keep the HOB elevated to at least 30 degrees unless medically contraindicated. Vent circuit - do not change routinely; change when visibly soiled / malfunctioning. Periodically drain / discard condensate in tubing – away from patient All these CDC recommendations are at level IA: Use a continuous subglottic suction ET tube for all intubations expected to be > 24 hours. Keep the HOB elevated to at least 30 degrees unless medically contraindicated. Vent circuit - do not change routinely; change when visibly soiled / malfunctioning. Periodically drain / discard condensate in tubing – away from patient

    15. Pulmonary Artery Pressure Measurement Alert 15

    16. Pulmonary Artery Pressure Measurement Alert 16

    17. Pulmonary Artery Pressure Measurement Alert 17

    18. Pulmonary Artery Pressure Measurement Alert 18 Respiratory Variation

    19. Pulmonary Artery Pressure Measurement Alert 19

    20. Pulmonary Artery Pressure Measurement Alert 20

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