PA catheter help/question

[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.

[kool-aide, RN]

Clamping is important to prevent air emboli

[MunoRN, RN]

I actually can't ever remember having to change the pressure tubing on a Swan because I rarely if ever see them left in that long. On pressure lines that we do change we usually have a three way at the connection that can be closed or a pinch clamp (such as on a triple lumen slic). I would avoid using hemostats to clamp the line.

[RN-LOGIC]

You should have enough time to switch your lines without worries of an air embolism. Of course, do one line at a time. Most of the time you should have blood return from your lines. The key here is that once you change your pa cath pressure tubing is to aspirate blood from the three way connection coming from the pa to prevent bubbles and make sure that the line is completely prime. The cvp you definitely have to aspirate because you are connecting it to the slic in the catheter, aspirate in the transducer. Make sure that you flush your pa cath with the three way connector turn towards the pa cath so you can flush any remaining blood in the connector. Pinching the tubing would not hurt the patient. Your patient should be flat on the bed as a preventive measure. Hope this helps.

[StayLost, BSN, RN]

The patient does not need to be flat for zeroing lines- in fact, the lines don't even need to be connected to the patient to be zero'd. We lay patients flat when we zero so that we can get the most accurate numbers, specifically the CVP. The 'flat and level' CVP is the most accurate.

When I change pressure lines, I usually just kink the line before connecting the fresh line/stopcock. If you find it too stiff to kink, you can wrap a 2X2 and kelly clamp.