Wedge pressure measurements

Inflate balloon slowly, monitoring the waveform to avoid overwedging and potential vessel rupture especially if elderly and/or pulmonary hypertensive. The trace should only 'wedge' after >1.3ml air has been injected.

Measure at end-expiration when intrathoracic pressure is closest to atmospheric pressure. For ventilated patients end expiration = lowest wedge reading; during spontaneous breathing end expiration = highest reading. Measurement is difficult in the dyspnoeic patient; a 'mean' wedge reading may be used in this instance.

The PAWP cannot be higher than the PA diastolic pressure.

CVP, PAWP and CO should not be measured during rapid volume infusion but after a period of equilibration (5-10 min).

The PAWP does not equal the LVEDP in mitral stenosis. In mitral regurgitation measure PAWP at the end of the 'A' wave.

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