Pulmonary Artery Catheterisation

See Appendices and self PA catheter learning package in Registrars office.

The PA Catheter is not a resuscitation tool and should only be inserted in a controlled environment after discussion with the Duty Specialist.

Decreasing use of the PA catheter has resulted in a loss of familiarity with its use.  Registrars and nursing staff not familiar with this instrument should not manipulate / advance / inflate the PA catheter balloon.

Indications

• Haemodynamic measurement (CO, SV, SVR)

• Measurement of right heart pressures (pulmonary hypertension, pulmonary embolus)

• Estimation of preload to the left ventricle (controversial)

Insertion

PA catheter insertion is technically difficult and requires a working knowledge of right heart pressures and waveforms.  They should only be inserted by accredited staff.

Monitoring PA Trace

An adequate tracing should be visible on the monitor at all times.  A damped tracing may represent a wedged catheter, clot at the catheter tip or inappropriate equipment set-up (wrong monitor calibration, faulty pressure transducer).

• Flush the distal lumen generously (using closed mechanism)

• Withdraw catheter until a trace is present

Never withdraw the catheter with an inflated balloon

Measurements of Pressures

• Pressure should be referenced to the mid-axiliary line

• The true wedge pressure is measured at end-expiration

 
PEEP may influence wedge pressures, however this is not a factor at PEEP < 10mmHg, and patients should not be disconnected from the ventilator to measure PAC pressures.

Measurement of Haemodynamics

Cardiac output measurement should only be attempted by staff familiar with the use of PA Catheters.  10mls, normal saline at room temperature is rapidly injected into the appropriate lumen.  This is usually repeated three times, with results varying >10% (normal) from average discarded.

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