Pulmonary artery catheterinsertion Insertion

1. Insert 8Fr central venous introducer sheath under strict aseptic technique. Pulmonary artery catheterisation is easier via internal jugular or subclavian veins.

2. Prepare catheter pre-insertion — 3-way taps on all lumens, flush lumens with crystalloid, inflate balloon with 1.6ml air and check for concentric inflation and leaks, place transparent sleeve over catheter to maintain future sterility, pressure transduce distal lumen and zero to a reference point (usually mid-axillary line). Depending on catheter type, other pre-insertion calibration steps may be required, e.g. oxygen saturation.

3. Insert catheter 15cm (i.e. beyond the length of the introducer sheath) before inflating balloon. Advance catheter smoothly through the right heart chambers. Pause to record pressures and note waveform shape in RA, RV and PA. When a characteristic PAWP waveform is obtained, stop advancing catheter, deflate balloon and ensure that PA waveform reappears. If not, withdraw catheter by a few cm.

4. Slowly re-inflate balloon, observing waveform trace. The wedge recording should not be obtained until at least 1.3ml of air has been injected into the balloon. If not, withdraw catheter 1-2cm and repeat. If 'overwedged' (pressure continues to climb on inflation), catheter is inserted too far and balloon has inflated forward over distal lumen. Immediately deflate, withdraw catheter 1-2cm and repeat.

5. After insertion, a CXR is usually performed to verify catheter position and to exclude pneumothorax.

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