Page 117 - Critical Care Nursing Demystified

102 CRITICAL CARE NURSING DeMYSTIFIED

TABLE 3–5 Pressures Obtained by Pulmonary Artery Catheter (PAC) (Continued)
Pressures Normal Value What They Mean
Cardiac output (CO) 4–8 L/min Volume of blood pumped out of
ventricle each minute. Can be
calculated via a computer after
injecting the PAC with saline
through the CVP port.
Cardiac index (CI) 2.5–4.2 L/min/m 2 Takes into account body size and
surface area. CO individualized.
Systemic vascular 770–1500 dynes/ Afterload. Pressure the left
resistance (SVR) s/cm –5 ventricle to work against to
eject blood into the aorta.

H ? How to Do It—Nursing Responsibilities

o I
o D
o
w t
ur
s
t—N
in the Care of a P
in the Care of a Patient During Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
Insertion of a PAC
Insertion of a PAC
et up the pr
ansdu
c
essuriz
ed line and tr
.

1
S
1. Set up the pressurized line and transducing equipment according to protocols
using sterile technique. The IV tubing must be kept free of air bubbles. If air enters
u sing st erile t echnique . T he IV tubing mus t
t
th
the catheter, it can migrate into the pulmonary artery and lodge in that circulation.
i
l
th
t
t
it
i
th
2. While the patient is in a supine position, level the zeroing stopcock to the pa-
tient’s phlebostatic axis (4th ICS, midaxillary line). This is the level of the atria.
This is an extremely important procedure as leveling at the wrong area can
change the waveforms and pressure values.
3. Attach the port to the distal end of the PAC to the monitor cable.
4. Read the values and record them as the catheter transits through the heart and
finally comes to rest in the pulmonary artery.
5. Inflate the balloon through the pulmonary capillary wedge pressure (PCWP)
port with less than 1 mL of air until the waveform changes from a PA to PCWP.
Record your values. Let the air rebound out of the syringe, watching for the
waveform to change back to PA.
6. Flush the catheter thoroughly by activating the manual flush device.
7. Place a sterile dressing on the insertion site when catheter insertion is com-
pleted: date, time, initial dressing.