Page 319 - Clinical Application of Mechanical Ventilation

Hemodynamic Monitoring 285

10 cm Close-Up of
Markings Cross-Section Catheter Tip
Proximal
Lumen Thermistor
Opening Lumen Thermistor
Lumen
Opening
Opening
Inflation
Lumen
Balloon
Distal Inflated
Lumen

Proximal
Lumen
Thermistor —IV Line
Lumen Port Cardiac
Output
Thermistor
Lumen
Distal Lumen
Distal Inflation Opening
Lumen Lumen Port
Port © Cengage Learning 2014
Proximal For Balloon
Lumen Inflation with
Port 1.5 mL of Air
Figure 10-6 Components of a Swan-Ganz (pulmonary artery) catheter.

The pulmonary artery catheter is placed within the pulmonary artery, and it can
measure the pulmonary arterial pressure (PAP) and the pulmonary capillary wedge
pressure (PCWP). Since it is inserted at the same site as the CVP catheter, it has
similar complications as well as additional ones related to balloon inflation, such as
pulmonary artery hemorrhage and pulmonary infarction.
The pulmonary artery catheter (Figure 10-6) has a number of variations but
typically it is 110 cm in length with three lumens (interior channels). The exterior
of the catheter is marked off in 10-cm segments by thin and thick black lines to
estimate the catheter tip location on insertion. At the tip of the catheter there is
an opening (PA distal lumen or port) connected with one lumen. About 30 cm
back from the catheter tip there is another opening (proximal injectate port) con-
nected to another lumen. When properly inserted, this proximal port is in the right
atrium. Near the catheter tip is a small (1.5 mL maximum inflation volume) balloon
connected to a lumen that allows for inflation of the balloon with a syringe. Also
at the catheter tip is a thermistor (temperature-sensing device) connected to a wire.

Insertion of Pulmonary Artery Catheter

The pulmonary artery catheter is usually inserted into either the subclavian or internal
jugular vein. From there, it is advanced to the superior vena cava and right atrium. The
balloon is then inflated and the blood flow moves the catheter with its inflated balloon
just as the wind moves a sail. The catheter proceeds to the right ventricle and into the
pulmonary artery where it will eventually “wedge” in a smaller branch of the pulmonary
artery. The balloon is then deflated and the catheter stabilized in place (Figure 10-7).

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