Help re: PA catheter care

[Teddy11]

Hi

I am new to critical care nursing and had a question about changing pressure tubing on PA lines. Once PA line, CVP injectate, etc are primed and ready to connect to patient, does the patient have to be flat to switch over tubing? I know for zeroing, CO, insertion/removal you do but to change over lines specifically does it matter? I was also taught you needed to clamp/pinch the CVP and PA catheter prior to the switchover - what have you found to be the best way with the stiff PA/CVP catheter, pinching or using clamp? I heard you should not use a hemostat to avoid damaging the line.

Appreciate any insight.

[Esme12, ASN, BSN, RN]

You use the manufactures clamp to switch over tubing. We usually leave the stopcock in position once attached at insertion. Once the stopcock is in position you withdraw blood then turn the stopcock and flush with fluid then you can turn it back on to the patient.

DO NOT USE A HEMOSTAT you WILL fracture the tubing. What does your policy state?

[Teddy11]

No clamp noted with it or it's removed at insertion and not used? Not sure. Have not yet experienced Swan insertion experience. I know some change it at the stopcock, but most go to the hub and not leave the stopcock/tubing on longer than policy (96 hrs). Only see insertion policy and general maintenance, nothing specific related to actual clamping.

[Here.I.Stand, BSN, RN]

I was never taught that the pt had to be flat to change the pressure line. Clamp w/ the manufacturer's clamp. Sure, pinching the line off works but who wants to use a hand when the clamp will do? We have too few hands already. Never, ever a hemostat.

[Teddy11]

Thanks

[Teddy11]

Thanks for your response. I feel so much better...felt awful about it, but I guess it happens. Explains why some change at the stopcock and not to the hub. Will have to see if clamps in the kit and perhaps not integrated onto the lines during or post insertion?

[StayLost, BSN, RN]

Your patient does not need to be flat when changing the pressure lines to a swan

What I usually do is kink the PA and CVP before inserting the new line, then draw back any possible air from the new stopcock. There are times when I use kelly clamps/hemostats by wrapping a 2X2 around PA or CVP before clamping it-- for instance when I am trying to detangle lines and I disconnect for some time.

In order to Zero the transducer, the patient does not have to be flat-- remember, when zeroing the stopcock is off-to-patient. In fact, it doesn't even need to be connected to a patient to be zero'd to atmospheric pressure.For instance, when placing a swan through an introducer, the PA must be zero previously, as they use the various waveforms in each chamber of the heart to guide them for placement. I would suggest looking at the you tube video "Floating a Swan".

Historically, the reason that we lay patients flat when we are zeroing because the CVP is most accurate when the patient is flat with the transducer level'd to the 4th intercostal midaxillary space.

[sallyrnrrt, ADN, RN]

esme12 & staylost gave you the most accurate and useful information. :)