Page 118 - Critical Care Nursing Demystified

Chapter 3 CARE OF THE PATIENT WITH CRITICAL CARDIAC AND VASCULAR NEEDS 103

NURSING ALERT

After performing the PAWP, the nurse must deflate the balloon and look for the return

of the PAP waveform. If the balloon is left inflated, a pulmonary infarction could
occur distal to the balloon as the circulation to that area is diminished by the balloon
blocking the pulmonary artery.

NURSING ALERT
Strict sterile technique is mandated in the care and manipulation of all invasive

arterial catheter insertions. Adhere to facility protocols for all tubing, catheter, flushes,
dressing changes, and maintenance.

4 ? 4 How to Do It—Nursing Responsibilities How to Do It—Nur

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1. Set up a cooling tower with an IV in place or use normal saline (NSS) at room
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2. Attach injectate to the central venous pressure (CVP) port with a screw-type
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adaptor. This will be injected into the CVP port 10 mL at a time.
3. Maintain the sterility of all attachments or endocarditis and sepsis can result.
4. Attach thermistor port to the cardiac monitor. This will calculate the change in
temperature over the period of time that a 10-mL bolus of iced saline/NSS is
injected into the CVP port.
5. Set the monitor up to measure cardiac output (CO) as per unit protocol.
6. Inject 10 mL of the iced saline or NSS into the CVP port.
7. Assess the waveform for an even upstroke and down stroke.
8. Perform CO readings three times in a patient where fluid is not a problem and
twice in a patient on fluid restriction.
9. Average the two or three values.
10. Input the patient’s height and weight into the monitor.
11. Read cardiac index (CI).
12. Compare the readings to previous readings. Call the primary health care pro-
vider if readings show a significant change.
13. Detach cables from the CVP port if needed as well as thermistor port.