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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

Pulmonary Artery Pressure Measurement

Issued May 2004

Pulmonary Artery Pressure Measurement Alert

lecture content
Lecture Content
  • Patient Positioning
  • Identify Phelbostatic Axis
  • Leveling
  • Square Wave Test
  • Obtain PA Reading

Pulmonary Artery Pressure Measurement Alert

patient positioning
Supine

Head of bed: 0-60°

Patient Positioning

Angels 45º

30º

Pulmonary Artery Pressure Measurement Alert

leveling
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

identify phlebostatic axis
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

slide6

Mark location chest wall

with washable felt pen

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

level transducer system
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

level transducer system8
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

Pulmonary Artery Pressure Measurement Alert

slide9

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

square wave test
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

under damped system
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

over damped system
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

pap documentation
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

respiratory component
Respiratory Component
  • Changes in intrathoracic pressure

during respiration change PAP

readings

  • Record and trend pressure readings at end expiration

Pulmonary Artery Pressure Measurement Alert

slide15

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide16

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide17

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

respiratory variation
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

slide19

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide20

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide21

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide22

Used with permission of PACEP Collaborative

Pulmonary Artery Pressure Measurement Alert

slide23

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