AACN

1
AACN

• Pulmonary Artery Pressure Measurement

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Lecture Content

• Patient Positioning
• Identify Phelbostatic Axis
• Leveling
• Square Wave Test
• Obtain PA Reading

AACN PAP Measurement Practice Alert
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PATIENT POSITIONING

• Supine
• Head of bed 0-60

AACN PAP Measurement Practice Alert
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LEVELING

• Eliminates effects of hydrostatic forces on the
  observed hemodynamic pressures
• Ensure air-fluid interface of the transducer is
  leveled before zeroing and/or obtaining pressure
  readings
• Phlebostatic axis
• Level of left atrium
• 4th ICS ½ AP diameter
• Mark the chest with washable felt pen

• AACN PAP Measurement Practice Alert

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IDENTIFY PHLEBOSTATIC AXIS

• Intersection of the 4th ICS and ½ the
  anterior-posterior diameter of the chest

McHale DL, Carlson KK. AACN Procedure Manual for
Critical Care 4th ed WB Saunders Philadelphia,
Pa 2001 (479) With permission from Elsevier
AACN PAP Measurement Practice Alert
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Mark location chest wall with washable felt pen
Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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LEVEL TRANSDUCER SYSTEM
Ensure air-fluid interface of the transducer is
level to phelbostatic axis
Used with permission of PACEP Collaborative

• AACN PAP Measurement Practice Alert

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LEVEL TRANSDUCER SYSTEM

• Relevel the transducer with any
• change in the patients position
• Referencing the system 1 cm
• above the left atrium decreases the
• pressure by 0.73 mm Hg
• Referencing the system 1 cm
• below the left atrium increases the
• pressure by 0.73 mm Hg

• AACN PAP Measurement Practice Alert

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SQUARE WAVE TEST

• Determines the ability of the
• transducer to correctly reflect pressures
• Perform at the beginning of
• each shift

• AACN PAP Measurement Practice Alert

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SQUARE WAVE TEST

• Figure A
• Expected square wave test
• Figure B
• Over damped
• Figure C
• Under damped

Reprinted from Darovic GO. Hemodynamic
Monitoring Invasive and Noninvasive Clinical
Application 2nd ed. Philadelphia,Pa WB Saunders
Co1995161-162 Used with permission from Elsevier

• AACN PAP Measurement Practice Alert

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UNDER DAMPED SYSTEM

• Over responsive, exaggerated, artificially spiked
  waveform
• SBP erroneously high DBP erroneously low
• Causes small air bubbles, too long of tubing,
  defective transducer

Reprinted from Darovic GO. Hemodynamic
Monitoring Invasive and Noninvasive Clinical
Application 2nd ed. Philadelphia,Pa WB Saunders
Co1995161-162 Used with permission from Elsevier

• AACN PAP Measurement Practice Alert

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OVER DAMPED SYSTEM

• Sluggish, artificially rounded blunted
  appearance
• SBP erroneously low DBP erroneously high
• Causes large air bubbles in system, compliant
  tubing, loose/open connections, low fluid level
  in flush bag

Reprinted from Darovic GO. Hemodynamic
Monitoring Invasive and Noninvasive Clinical
Application 2nd ed. Philadelphia,Pa WB Saunders
Co1995161-162 Used with permission from Elsevier

• AACN PAP Measurement Practice Alert

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PAP DOCUMENTATION

• Measure at end expiration
• Measure pressures from a graphic tracing
• Measure pulmonary capillary wedge pressure at
  end-expiration using the mean of the a wave
• a wave indicates atrial contraction and falls
  within the P QRS interval of the corresponding
  ECG complex

• AACN PAP Measurement Practice Alert

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RESPIRATORY COMPONET

• Changes in intrathoracic pressure during
  respiration change PAP readings
• Record and trend pressure readings at end
  expiration

• AACN PAP Measurement Practice Alert

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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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RESPIRATORY VARIATION
Mechanical ventilation
Spontaneous ventilation
Aherns Ts, Taylor LK. Hemodynamic Waveform
Analysis. Philadelphia, Pa WB Saunders 1992
27 Used with permission from Elsevier

• AACN PAP Measurement Practice Alert

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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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Used with permission of PACEP Collaborative
AACN PAP Measurement Practice Alert
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• Thanks
• for your attention