Pulmonary Artery (PA) Catheter (Nursing)

00:01 Our next invasive hemodynamic monitoring is our pulmonary artery pressure monitoring.

00:06 This is the most invasive monitoring that we have that would involve a PA catheter or pulmonary artery catheter, which is a balloon tip catheter that terminates in the pulmonary artery and delivers a multitude of hemodynamic information from the patient.

00:21 Things such as cardiac output and index, mixed venous, pulmonary artery pressures, central venous pressure, core temperature, wedge pressure, systemic vascular resistance and a whole host of other information come from this one catheter.

00:40 Next, we're going to discuss the PA catheter components.

00:43 First, we're going to look at this big blue blade, which is the SPO2 connector.

00:48 When you hook it up to your monitor, it's going to read the mixed venous oxygenation in your pulmonary artery.

00:54 The next portion is this big blue round one.

00:57 This is your thermal filament connector.

00:59 This is where you get your cardiac output and index.

01:03 The next part here is this little white one.

01:06 This is your thermistor connector.

01:08 This is where we get our core temperature.

01:10 Next, we're going to go to our ports, okay.

01:13 The white one is our infusion port.

01:16 This is where we can infuse medications.

01:18 It's also called a volume infusion port or a medication line.

01:23 Then we're going to go to our blue port.

01:26 This one is our central venous port.

01:28 This is where we get our central venous pressure in the right atrium, also called a proximal port.

01:34 And then the last port is our yellow port.

01:36 This is called our distal port.

01:38 This is where we get our pulmonary artery pressures.

01:42 Then our red one here is our balloon port.

01:46 This is what inflates the balloon in order to get a wedge pressure.

01:51 On it you have a lock.

01:53 When the lines are lined up the red lines, it is unlocked and you can inflate the balloon.

01:59 When it's locked, you're unable to inflate the balloon.

02:04 Another special consideration with a pulmonary artery catheter involves infusion of medications through the pulmonary artery distal port.

02:13 Remember, this port is going right into the pulmonary artery.

02:17 You should not infuse anything else but normal saline into this lumen.

02:22 If you infuse more anything else you could call pulmonary infarction.

02:30 Next, let's talk about the distal end of the PA catheter.

02:33 At the very end of it, you have one hole and an infrared sensor.

02:38 The hole is the PA distal opening.

02:42 That's where if we had fuse sailing through the PA port, this is where it comes out at.

02:46 Look closely as I infused saline through the PA line.

02:51 Now we see where the comes out at.

02:53 This is going to sit in the pulmonary artery.

02:55 At the end of it is also what I called that infrared light that is going to read your mixed venous oxygenation.

03:03 A little bit up from that, we have our balloon.

03:07 Watch as I inflate this balloon with 1 1/2 cc's of air.

03:12 As I let the syringe go, it'll deflate on its own.

03:16 Proximal from our balloon is our thermal filament.

03:19 This is our brown port, where we get our core temperature from.

03:23 A little bit upstream from that is our CVP port.

03:27 Okay, so if you infuse anything through that CVP port, it comes out right there.

03:35 And a little bit proximal from that on the 30 centimeter line is our infusion port that usually sits again in the superior vena cava.

03:44 If you infuse medications like through that, like I'm doing now, it comes out right there in inferior or superior vena cava.

03:54 Now with this, we have markings on here which are depth gauges.

03:57 So one tiny thin line is 10 centimeters.

04:03 Going up from there, we have one thick band, that's our 50 cm mark.

04:11 So one thin band and one thick band would be our 60 cm mark.

04:15 One special consideration I want to show you is how do you leave the balloon syringe and the balloon lock when you're not with the patient.

04:25 The way I was taught when I first started was to leave the lock locked and with no air in the syringe.

04:33 Because the thought was that if there's no air in the syringe and it's locked, then there's no way that the patient can accidentally inflate the balloon and cause pulmonary infarction.

04:43 The problem I found was that when you come into a room and you see this, you don't know if there's actual air in that balloon.

04:53 So just like this.

04:55 I have it just like this, but I don't know if there's air in that balloon, right? So I look up at my PA waveform, and maybe it's not wedged right now.

05:02 But if I turn the patient, this may start blocking blood flow and then I get a wedge waveform.

05:09 I have times went into a room and I've unlocked the syringe like this and it's come back which means that there is air in that syringe or in that balloon.

05:20 So the way I teach my nurses is to leave it unlocked with no air in the syringe, okay.

05:29 The reason is if it's unlocked like this, with no air in the syringe there could not possibly be air in the balloon.

05:37 If there was air in the balloon, it would come back and and go into the syringe.

05:43 So if I come into a room and I've taken care over a patient, maybe the nurse was with the patient the whole night and and I'm taking over and I see that this is unlocked with no air in the syringe, that means there cannot possibly be air in that balloon.

06:05 On this PA catheter we have different size bands, we have one thin band and in thick bands.

06:11 One thin band indicates 10 centimeters.

06:15 A thick band indicates 50 centimeters.

06:18 One thin band together with one thick band is going to be 60 cm.

06:23 This is in order for us to measure the depth that the PA catheter is in the patient.

06:28 This is important to know because the PA catheter may get pulled on and moved out and we get a good indication of if it's been adjusted because of the depth markings that that it's at.

06:40 Our next PA catheter component is our catheter contamination shield.

06:44 This maintains a sterile PA line that's outside of the patient.

06:48 We need a portion that sterile so that if we need to adjust the length or depth of the PA catheter in the patient, we could push it in a little bit more and have a sterile portion going into the patient rather than an unsterile and it's introducing bacteria.

07:03 This catheter contamination shield locks it both ends.

07:06 So it prevents it from getting pulled out or pushed in by accident.