Swan Ganz Catheter
Trouble Shooting:
1. It is importrant to monitor the PAP tracing continuously.  (Spontaneous catheter tip migration toward the periphery of the pulmonary bed may occur.)
2.  Identify patients who are high risk for PA rupture:  women (especially over age 60), history of cardiac or vascular disease, elevated PA pressures, pulmonary hypertension, anticoagulation therapy.
3.  Determine if waveform is dampened vs. spontaneous wedge.
If Dampened:
a. check that pressure in the flush bag is at 300 mmHg
b.check that flush bag is not empty
c. check for loose connections
d. check for air bubbles present in the system
3.  If spontaneous edge:
a. DO NOT flush catheter
b.DO NOT inflate balloon. Remove syringe to ensure balloon delfates completely.
c.Gently pull back PA catheter 3 cm while securing introducer
d.  Maintain sterility of catheter with the contamination shield (fellow saver)
e.  If unable to pull catheter back, notify MD immediately.
4.  If PA catheter remains wedged pul back an additional 3 cm.
5.  Call MD to notify of wedge catheter.
6.  Monitor patient for pulmonary injury:
a.  Hemoptysis:  position pt. with the affected side down (usually the right side) to prevent blood from spilling inot the unaffected side.
b.  Monitor SaO2 continuously
c.  MD must reposition catheter to prevent further injury to lung.

Spontaneous
Wedge:
During patient repositioning, transport or patient movement, the Swan Ganz catheter may advance into the capillary bed.  This spontaneous wedge happens without balloon inflation and may cause damage to lung tissue downstream if it 
Dampened Waveforms--Even small air bubbles in the transducer lines will cause the waveform to dampen.
Overwedge-- If the balloon inflates in too small a capillary, the wave form will go to the top of the scale, and the capillary may be damaged.