Site Care and Catheter
- A sterile dressing is
placed over the insertion site and the catheter is taped in place. The insertion
site should be assessed for infection and the dressing changed every 72 hours
- The placement of the
catheter, stated in centimeters, should be documented and assessed every shift.
- The integrity of the
sterile sleeve must be maintained so the catheter can be advanced or pulled
back without contamination.
- The catheter tubing should
be labeled and all the connections secure. The balloon should always be
deflated and the syringe closed and locked unless you are taking a PCWP measurement.
Patient Activity and
- Many physicians allow
stable patients who have PA catheters, such as post CABG patients, to get
out of bed and sit. The nurse must position the patient in a manner that avoids
- Proper positioning during
hemodynamic readings will ensure accuracy.
- Continuous EKG monitoring
is essential while the PA catheter is in place.
- Do not advance the catheter
unless the balloon is inflated.
- Antiarrhythmic medications
should be readily available to treat lethal dysrhythmias.
for Proper Catheter Placement:
- The nurse must be vigilant
in assessing the patient for proper catheter placement. If the PA waveform
suddenly looks like the RV or PCWP waveform, the catheter may have become
misplaced. The nurse must implement the proper procedures for correcting the
Values for Response to Treatments:
- The purpose of the PA
catheter is to assist healthcare team members in assessing the patients
condition and response to treatment. Therefore, accurate documentation of
values before and after treatment changes is necessary.
Assessing the Patient
for Complications Associated with the PA Catheter:
- Occluded ports
- Balloon rupture caused
by overinflating the balloon or frequent use of the balloon.
- Pneumothorax - may occur
during initial placement.
- Dysrhythmias - caused
by catheter migration
- Air embolism - caused
by balloon rupture or air in the infusion line.
- Pulmonary thromboembolism
- improper flushing technique, non-heparinized flush solution.
- Pulmonary artery rupture
- perforation during placement, overinflation of the balloon, overuse of the
- Pulmonary infarction
- caused by the catheter migrating into the wedge position, the balloon left
inflated, or thrombus formation around the catheter which causes an occlusion.
catheter migration may cause which of the following complications?