Following return of the pulmonary artery tracing, slowly inflate the balloon and assess the pulmonary artery wedge pressure. If it takes less than 1 cc to inflate the balloon, carefully withdraw the catheter an additional .5 - 1 cm. Recheck the pulmonary wedge. When a spontaneous wedge pattern develops, the catheter is too distal. The catheter needs to be withdrawn enough to ensure adequate blood flow continues around the catheter following balloon deflation.
Monitor waveform closely for right ventricular or spontaneous wedge tracing.
If a right ventricular tracing is noted, withdraw the catheter to the right atrium as per procedure below. If the catheter is withdrawn too far, it could slip into the right ventricle. The catheter could return to a spontaneous wedge pattern, requiring further adjustment. Notify the physician. At the earliest opportunity, the physician should assess the catheter for placement.