Page 119 - Critical Care Nursing Demystified

104 CRITICAL CARE NURSING DeMYSTIFIED

Nursing Assessment for Complications The nurse should be observant for all possible
complications when caring for a patient with a PAC.
• Pneumothorax – The introducer or catheter may accidentially pass through
the vessel walls especially on insertion into the subclavian vein. Observe
for diminished breath sounds in the lungs, decreased SaO , and chest x-ray
2
changes.
• Infection – The PAC is an invasive procedure and the catheter passes
through the heart. Look for signs of sepsis like fever and elevated white
blood cells (WBCs).
• Ventricular dysrhythmias – These are caused when the catheter whips up
against the endocardium creating an irritable focus. They might only be
seen on insertion as the catheter coils back on itself to pass through the
pulmonary artery. Notify the physician; the catheter may need to be ad-
vanced so that it does not migrate back to the right ventricle.
• Pulmonary infarction – This can be caused if the catheter is left in a
“wedged position.” Always watch the pattern return to a PA pattern after
performing a PCWP reading. Notify the health care provider if suspected. The
catheter may be pulled back and repositioned by the health care provider. 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.
• Pulmonary artery rupture – This is one of the most serious issues and can
be caused by overinflation of the balloon while performing PCWP or on
insertion. Look for signs of hemorrhage and shock.

Cardiac Catheterization (CC)
A CC is a study to measure pressures in the heart and to visualize flow of
blood via a dye injected into the heart chambers or coronary arteries. CC tells
how the heart is functioning and whether any of the coronary arteries is
blocked. An extensive medical/surgical history must be done prior to this test
as well as laboratory values for coagulation (PT, PTT), bleeding (H&H), and
kidney function (BUN and creatinine). Baseline coagulation studies tell if the
patient will be prone to bleeding before and after the procedure. Potential
hidden bleeding into the groin is monitored by the H&H and lastly, since the
dye is nephrotoxic, kidney function must be screened to see if the patient can
excrete the dye.
The patient’s heart is accessed through a femoral puncture. If the patient has
a right-heart catheterization, the femoral vein is punctured, and if it is a left-
sided heart catheterization, the femoral artery is punctured. Once the pressures
are obtained, dye is injected to see the function of the chambers of the heart
and visualize the coronary arteries (left-sided heart catheterization only). The