Nursing Responsibilities

Site Care and Catheter Safety:

• 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 and prn.
• 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 Positioning:

• 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 dislodging the
  catheter.
• Proper positioning during hemodynamic readings will ensure accuracy.

Dysrhythmia Prevention:

• 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.
  

Monitoring Waveforms 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 situation.
  

Monitoring Hemodynamic Values for Response to Treatments:

• The purpose of the PA catheter is to assist healthcare team members in assessing the patient’s 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 balloon.
• 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.

Instant Feedback: