STANDARD:
* The patient must be cardiac monitored during the procedure in an electrically cardiac isolated environment which conforms to Electrical Standard AS 2500, Section 4, 1986.
* Insertion by qualified medical practitioners or RMO under the direction of senior medical officer, until assessed as competent by senior medical officer.
* The procedure will be performed under the strictest aseptic conditions.
* The procedure will be explained to the patient and written consent will be obtained by the Medical Officer.
* Universal Precautions will be maintained throughout the procedure and in the clean up phase following the procedure.
* Patient safety will be maintained throughout the procedure.

OUTCOMES:
* The catheter will be located in the Pulmonary Artery.
* The risk of infection will be minimised.
* The patient will feel safe and secure during the procedure.
* There will be a defined clinical benefit for the patient from the performance of the procedure.
* The attendant risks involved in the performance of, and subsequent to the procedure will be monitored and managed within defined protocols.

SPECIAL
CONSIDERATIONS:
* Resuscitation trolley should be readily accessible.
* Patient bed should be able to be tilted in the Trendelenberg position. R : 26.1
* The insertion site e.g. jugular or subclavian area, should be exposed and clear of clothing, ECG dots, wires and jewellery.
* IV lines and infusion pumps should be primed with the prescribed fluid and ready for connection.
* The audible QRS tone on the monitor should be turned on during the procedure.
* Chest X-ray to be taken and reviewed by a medical practitioner as soon as practicable post insertion of a subclavian line.
* Transducer should be set to 4th intercostal space mid axillary line with patient in neutral position.

EQUIPMENT: Surgical mask (doctor and nurse) Sterile gown and gloves
Protective eyewear 1 large trolley drape
2 large patient drapes 2 small patient drapes
Alcohol chlorhexidine Arrow introducer set
5mls 1% plain Lignocaine 10mls Heparinized Saline 50 units in 5ml
2/0 black silk on straight cutting needle Stitch cutter
Pulmonary Artery Catheter Hansipore dressing or gauze dressing and micropore tape
2 lumen luer lock caps Transducers (cup and PAWP)
Space labs modules Pressure cables x 2
Heparinised saline 500mls Pressure infuser bags

NURSES ROLE: The nurse:
* remains with the patient throughout the procedure.
* prepares the patient, removing clothing, exposing the site area, repositioning ECG dots/wires.
* positions the patient in the Trendelenberg position.
* open packs and sets up for procedure.
* observes cardiac monitor during insertion of the guidewire/catheter.
* records Atrial, Ventricular, Pulmonary Artery and Wedge Pressure waveforms and pressures as the catheter is advanced.

Reviewed September 1995 R : 26.2