02.04 Pulmonary Artery Wedge Pressure (PAWP) for CCRN Review

Nursing Points

General

1. Pulmonary Artery Wedge Pressure (PAWP)
   1. AKA pulmonary capillary occlusion pressure (PCOP)
   2. Air into balloon -> to look at left side of heart
   3. Waves
      1. A (shows QRS) -> contraction of atria
      2. C (may no see, shows in A wave) -> mitral valve closes
      3. V (between T and P) -> atria fill
   4. Mean of A wave = the wedge (normal 4-12)
      1. Wedge should not be > PAD (pressure decreases as it moves through circulation)
         1. This means that reading is inaccurate
            1. Over wedged
            2. Catheter in wrong place
            3. Should be in zone 3 -> check X-ray
         2. Other ways to know…
            1. Wedge humps are more flat than usual or absent
            2. Wedge humps vary upon patient’s breathing
   5. PAWP is elevated with
      1. Left-sided heart dysfunction
      2. Mitral stenosis or insufficiency
      3. Cardiac tamponade
      4. Constrictive pericarditis
      5. Left ventricular failure
      6. Volume overload