Advanced Hemodynamics - Orlando Health

Advanced Hemodynamic Monitoring
intrapulmonary pressures will increase on inspiration and decrease on expiration. Therefore, the
point of end expiration will look different depending on how your patient ventilates. In the
spontaneously breathing patient, end expiration will be the highest point on the waveform before it
dips. Conversely, for the mechanically ventilated patient the end expiration will be the lowest point
on the waveform before it rises.
Keep in mind that the transducer must be properly leveled and zeroed prior to assessing any values.
If too high, it will give a falsely low reading, and if too low, it will give a falsely high reading.
PA waveform
Please note that the pulmonary artery waveform has the same characteristics of the arterial
waveforms. What you should see is a sharp upstroke that represents systolic ejection into the
pulmonary artery. This is followed by a dicrotic notch that represents closure of the pulmonic
valve, and subsequent gradual downslope that is representative of end diastole and opening of the
pulmonic valve.
PAOP (wedge)
Normally when the PA catheter is resting in the pulmonary artery it will display the PAS and PAD.
The PAOP/PAWP is obtained from the distal port of the PAC when the balloon is inflated. To
inflate the balloon, inject with up to 1. 5 ml of air or until a wedge waveform is produced. The
balloon should not be inflated for longer than fifteen seconds. It is important to document how
much air it took to produce a PAOP waveform to assess for catheter migration. The air should then
be allowed to passively escape into the syringe. The wedge waveform can be frozen on the monitor,
so clinicians can assess for the values after the procedure is completed.
DO’S AND DON’TS OF WEDGING
Never wedge for more than 15 seconds
Never leave the catheter in a permanent wedge position
Always allow for passive deflation of the balloon
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