Page 501 - Cardiac Nursing

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C HAPTER 2 1 / Hemodynamic Monitoring 477

60

0.30
0.32 “V”
“V”
PAS 40

WEDGE
PAEDP
20

■ Figure 21-14 PA pressure or PAOP? In the presence of a large V wave, the PAOP tracing may mimic a PA
tracing. Comparison of the PA and PAOP relative to the ECG reveals the following: (1) the v wave of the PAOP
occurs during the TP interval, whereas the initial systolic upstroke of PA waveform is closely related to the end
of the QRS complex; and (2) the PA v wave is a sharp upward deflection on the descending limb of the PA
pressure curve, having the same temporal relation as the v wave in the PAOP tracing. PAOP 30 mm Hg.

introduce error into pressure measurements and potentiate thera- may be poorly tolerated in patients with increased intracranial
peutic mismanagement of critically ill patients. pressure or cardiopulmonary dysfunction. Research has shown
that in a wide variety of critically ill patients, accurate PA pressures
Positioning can be obtained in the supine position with legs extended and a
Traditionally, PA and PAOP measurements have been obtained backrest elevation up to 60 degrees. 195 Measurement of PA pres-
with the patient in the flat, supine position; however, this position sures in the sitting position (legs dependent) is not recommended.

PAS
60 PAS “V”
60
40 “a”
40
20 PAEDP
MECH VENT SPONT INSP 20 PAEDP
0
A B
■ Figure 21-15 PA pressure determination. (A) Elevated PA pressure related to LV failure and ARDS. Patient
is on intermittent mandatory ventilation. PAS 58 mm Hg; PAEDP 30 mm Hg; PA mean 38 mm Hg.
(B) Patient with vegetation on mitral valve resulting in acute mitral insufficiency. Note the v wave on the down-
stroke of the PA waveform (bifid waveform). PAS 68 mm Hg; PAEDP 32 mm Hg; PAM 48 mm Hg.