DOI: 10.1097/CCM.0b013e3181a097ba
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Issn Print: 0090-3493
Publication Date: 2009/05/01
Obtaining pulmonary artery catheter data is too labor intense to be reliable
Excerpt
I am writing with reference to the Special Article: Point of View, entitled, “The Pulmonary Artery Catheter: In Medio Virtus” by Jean-Louis Vincent et al (1). Although I fully appreciate and agree with the viewpoints stated by the esteemed physicians contributing to this article, I cannot resist sharing a nursing perspective. I am a clinical nurse specialist and responsible for teaching hemodynamic monitoring to our new nursing staff. I am also involved in pulmonary artery catheter (PAC) monitoring skills competency for our seasoned staff. Unlike Svo2 and cardiac output readings, pressure monitoring with the PAC requires tedious attention to detail. Besides zeroing and calibrating, the most simplistic aspects of insuring system accuracy, a square wave test must be completed to assess dynamic response. If the test is unsatisfactory (not uncommon), then measures are required to improve it including removing air bubbles, clots, and kinks or perhaps applying a dampening device. To obtain accurate pressures, readings must be taken manually at end expiration, a point that varies considerably between spontaneous breathing and mechanical ventilation. For the central venous pressure and pulmonary artery occlusion pressure measures, the “a” wave has to be identified and defined. All of these highly technical skills are mind boggling to new orientees and far too time consuming for busy intensive care unit nurses. In addition, with reduced use of the PAC, it becomes even more difficult for nurses to recall all the inexorable details for getting the data right. I have far more fear about the potential harm that can come from applying erroneous PAC information to a patient’s care than harm from having no PAC information at all.
The author has not disclosed any potential conflicts of interest.
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