“The wedge.”

The holy grail of RHC and hemodynamics

Hate it or love it, major decisions are made based on it

Whether you:
• Perform the procedure yourself
• Review someone else’s tracings
• Review someone else's report
 
Learn 7 tips to ensure “the wedge” accuracy BUT FIRST!

You received the following RHC report:
PA Systolic         51 mmHg
PA Diastolic       22 mmHg
PA Mean            32 mmHg
Mean Wedge    30 mmHg

Should you REPEAT one of the values :
(answer before continuing the 🧵; final answer at the end)

1/11

#PAC 101 (The Catheter)

A cath lab pt just arrived in your ICU with a pulmonary artery catheter (#PAC) in place.

Your bedside nurse (limited #PAC experience) asks you to walk her through the basic PAC lumens and ports 😱

Fortunately for you, you had bookmarked the 🧵 👇🏻 2/11 But first!

For those of you exposed to #PAC in your daily job:

How comfortable do you feel with the #PAC connections and setup (honest answers only; no one will know your individual answer)?

1/10
Avoiding a PA catheter #PAC nightmare! (bookmark this)

Evening rounds in ICU.
Pt with #PAC in place. “Wedge” 25 mmHg 2d ago. Great diuresis since.

Last 8h urine output is ⬇️
Time for wedge recheck

You fully inflate the #PAC balloon (1.5 cc)
1m later, heme is pouring👇🏻

2/10

Before we go on.

In your opinion, what is the scariest potential #PAC complication

[1] #Hemodynamics Tweetorial #2

Heart failure pt in ICU is -3.5L after 2d of aggressive diuresis. On day 3, urine output is ⬇️and BUN/Cr is ⬆️

You personally wedge #PAC at bedside and obtain a mean wedge 17 mmHg (a normal mean wedge is 6-10 mmHg). Admission wedge was 24 [2]
Question 1. Based on wedge 17 mm Hg (good waveform; no trick), you: