What is the most important nursing action when measuring a pulmonary capillary wedge pressure (PCWP)?
A. Have the client bear down when measuring the PCWP.
B. Deflate the balloon as soon as the PCWP is measured.
C. Place the client in a supine position before measuring the PCWP.
D. Flush the catheter with heparin solution after the PCWP is determined.
Correct Answer: B. Deflate the balloon as soon as the PCWP is measured.
While the balloon must be inflated to measure the capillary wedge pressure, leaving the balloon inflated will interfere with blood flow to the lung. Once the catheter is advanced into the pulmonary artery to the point where the waveform changes into a wedge form, the balloon should be deflated. The catheter will then show the PA pressures. After obtaining the appropriate PA pressures, a PCWP/pulmonary artery occlusion pressure can now be measured.
Option A: Bearing down will increase intrathoracic pressure and alter the reading. The balloon is inflated only until the PA pressure waveform changes into a wedged waveform. When the balloon is inflated, it creates a static column of blood between the artery distal to the catheter and the pulmonary vein. This post-capillary pressure, known as the PCWP, is an indirect estimate of the pressure in the left atrium.
Option C: While a supine position is preferred; it is not essential. The first step of the procedure is to clean the area with an antiseptic solution, and the patient is draped to make a sterile working field. Using a vascular probe, the position of the vessel is confirmed again. Following this, local anesthesia is provided at the site of insertion.
Option D: Agency protocols relative to flushing of unused ports must be followed. Once the procedure is done, a chest X-ray should be ordered to confirm the position of the catheter and to check for any complications. The tip of the PA catheter should not extend beyond 2 cm of the hilum and is usually within the mediastinal shadow.
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