Ateneo de Zamboanga University

College of Nursing

NURSING SKILLS OUTPUT

NAME: _____________________________ WEEK ROTATION: __________

CLINICAL AREA: ___________________ RLE DATE: _________________

PULMONARY CAPILLARY WEDGE PRESSURE

Definition:
A Pulmonary Capillary Wedge Pressure (PCWP) is frequently used to assess left
ventricular filling, represent left atrial pressure, and assess mitral valve function. It is measured by
inserting a balloon-tipped, multi-lumen catheter (Swan-Ganz catheter) into a central vein and
advancing the catheter into a branch of the pulmonary artery. The balloon is then inflated, which
occludes the branch of the pulmonary artery and then provides a pressure reading that is equivalent
to the pressure of the left atrium (Nair, 2022).
Purpose:
The purposes of Pulmonary Capillary Wedge Pressure are:
● To safely and accurately perform hemodynamic monitoring which provides information
about;
● To safely obtain a mixed venous gas from pulmonary artery as a reflection of overall
venous oxygen saturation (SvO2);
● To differentiate between different forms of shock;
● To measure the relationship between patient’s oxygen delivery and consumption.

Objectives:

The Objectives of PCWP are as follows:

a. Differentiate between cardiogenic pulmonary edema and noncardiogenic
pulmonary edema;
b. Confirm the diagnosis of pulmonary arterial hypertension;
c. Assess the severity of mitral stenosis;
d. Measure key hemodynamic parameters and assess response to therapy.

Equipment:

1. Hospital gown
2. Sterile gloves, gown and mask
3. Cardiac Output module and cable
4. Swan-Ganz Catheter
5. Syringes
6. Normal Saline
7. Heparin

Procedures and Steps (with rationale):

PREPARATION
1. Verify the doctor’s order.
Rationale: To ensure that the doctor has ordered the test.

2. Ask the patient or family/relatives to sign the informed consent form. Ensure this is
filled out according to hospital policy.

Rationale: Consent is important to ensure that patient has voluntarily agreed and has
understood information related to the procedure.

3. Assemble equipment and supplies.

Rationale: Preparation of the needed materials to be used prior to the procedure will
facilitate an efficient process.

4. Introduce yourself and verify the patient’s identity.

Rationale: To ensure the correct patient is assessed and to foster awareness regarding the
procedure to be done.

5. Provide privacy to make the patient feel comfortable.

Rationale: This is to ensure that the patient feels safe and respected during the procedure.

6. Perform hand hygiene and other infection control procedures.

Rationale: To deter the spread of microorganisms.

7. Provide the patient with hospital gown to change into. Ask patient to remove any
clothing, any body piercings, and jewelry.

Rationale: Any clothing, jewelry, or other objects that may interfere with the procedure
must be removed.

8. Assess patient’s vital signs.

Rationale: To obtain baseline data.

9. Don sterile gloves, protective gown, and mask.

Rationale: To reduce contamination of healthcare workers caring for patients with

transmissible infectious diseases.

10. Prepare pressurized and heparinized flush solution.

Rationale: 1-2 units heparin/mL reduces risk of catheter occlusion through thrombosis.

11. Assist with skin preparation and put patient in Trendelenburg position.

Rationale: To reduce normoflora at insertion site. This also inflates the internal jugular
vein making it an easier target during catheter insertion and decreases risk of air
embolism.

PROCEDURE
12. Assist physician or advanced practice nurse with flushing PA catheter ports with
sterile solution.
Rationale: Flushing reduces risk of air embolism during insertion. During this time, the
nurse and the physician will test the balloon port, the thermistor port, and connect the
pressure.

13. Connect the pressure line(s) to the distal and proximal ports. Connect monitoring
equipment and set scales and alarms for each parameter.
Rationale: Connecting pressure lines allows the physician to monitor pressure waveforms
and readings as the PA catheter is advanced through the cardiac chambers.
14. Level the transducers with the patient's phlebostatic axis and "zero" the transducers.
Rationale: Phlebostatic axis approximates the level of the right atrium for establishing
pressures in the circulatory system which enhances the accuracy of readings.
15. Instruct patient to take a deep breath and hold it prior to insertion.
Rationale: Increased intra-thoracic pressure reduces the risk of air embolism during
exchanges of dilator and catheter over guidewire.
16. After the PA catheter has been inserted a few inches, inflate the balloon port.
Rationale: Inflation of the balloon port in the right atrium allows the catheter to "float"
through the right ventricle into the pulmonary artery without irritating the ventricular wall.
17. Monitor cardiac monitor and hemodynamic waveform of distal port during catheter
insertion.
Rationale: Waveforms guide the insertion process as the tip of the catheter proceeds through
the different chambers. Ventricular ectopy can occur as the distal port travels through the
right ventricle.
18. As the distal port "floats" through the right ventricle, make a recording of the
waveform and record the systolic and diastolic pressures.
Rationale: Provides diagnostic information about right ventricular function.
19. When the inflated balloon finally occludes a pulmonary artery, record PAOP reading
and deflate the balloon passively.
Rationale: Deflation of the balloon prevents pulmonary infarction. Passive deflation means
unlocking the balloon port and removing the syringe.
20. Observe waveform and perform a dynamic response test (square wave test).
Rationale: To determine the location of the catheter and degree of waveform dampness.
21. Record PA systolic, diastolic, and mean pressures.
Rationale: Provides diagnostic data about left ventricular functioning.
22. Apply transparent occlusive dressing over insertion site. Inform patient the physician
will interpret the findings.
Rationale: Occlusive dressing prevents blood stream infections.
23. Assess the client’s vital signs for evidence of bleeding.
Rationale: Decreased blood pressure and increased pulse may imply the presence of
bleeding.
 24. Document all pertinent data such as the date, time, and completion of the
examination; the patient's return to the nursing unit; and for any side effects
experienced by the patient after the procedure.
Rationale: The findings will be sent to physician for further evaluation and to monitor
changes in clinical state from care provided.

Nursing Responsibilities:

A. Before the Procedure

1. Explain the procedure to the patient: Who will perform the test, where it will take
place, and the purpose of this procedure.
2. Assess patient for history of heart failure, COPD, head injury and cerebral bleeding
risk.
3. Assess for allergies to iodine, tape, Latex and ointments.

A. During the Procedure:

1. Position the patient in a manner that avoids dislodging the catheter as proper
positioning during hemodynamic readings will ensure accuracy.
2. Continuous EKG monitoring while the PA catheter is in place to assess for any
dysrhythmias.

B. After the Procedure:

1. Provide patient aftercare by removing the conductive gel from the patient’s skin.
2. Assess and take note of the puncture site for bleeding, redness, swelling or hematoma.
This is to assess for possible infections and other complications that may occur.
3. Accurate documentation of values before and after treatment changes is a nurse’s
responsibility to ensure accuracy in assessing the patient’s condition and response to
treatment.
4. Document accurately all pertinent information.

Illustration:

________________________________

Clinical Instructor
References:

Nair, R., & Lamaa, N. (2022, April 21). Pulmonary Capillary Wedge Pressure.
National Library of Medicine. Retrieved January 26, 2023,
from https://www.ncbi.nlm.nih.gov/books/NBK557748/#:~:text=Pulmonary%20capillary
%20wedge%20pressure%20is%20an%20integrated%20measurement%20of%20the,usef
ul%20in%20several%20diagnostic%20settings.

Truman State University. (n.d). Pulmonary Artery Catheters. Retrieved from

https://shadwige.sites.truman.edu/hemodynamic-monitoring-front-page/pulmonary-artery-
catheters/#:~:text=During%20insertion%2C%20it%20is%20the,dysrhythmias%20(catheter
%20placement).%5D