Training requirements for pulmonary artery catheter utilization in adult patients.

Objective: To review the literature addressing the issue of training requirements for pulmonary artery catheter (PAC) utilization in adult patients.

Data source: All pertinent English language articles dealing with training requirements for pulmonary artery catheterization were retrieved from 1984 through 1997.

Study selection: Articles were chosen if issues related to training and pulmonary artery catheterization were studied or reviewed.

Data extraction: From the articles selected, information about PAC training was obtained.

Data synthesis: The PAC is a commonly employed monitoring tool in the management of critically ill patients. Recent publications have strongly implied that PAC monitoring is associated with an increased morbidity and no notable clinical benefit. In response to these findings, the value of PAC monitoring has been questioned. The benefit assessment of any technology on clinical outcome presumes that the care provider possesses the skills and knowledge to optimally utilize the data obtained and simultaneously minimize the potential complications. Several recent articles have addressed physician and nurse knowledge as it pertains to PAC monitoring. The results of these studies are quite alarming. Marked deficiencies of knowledge were noted particularly in area of data interpretation and patient management. Extrapolating from their conclusions, it appears that any effort to proactively assess the value of PAC monitoring will be compromised until attempts are made to standardize and optimize the clinical skills of those involved in utilization of the technology. This article provides a proposed program for clinical education and raises the question regarding the necessity of demonstrated proficiency.

Conclusion: Training, credentialing, and continued quality improvement related to PAC should be improved.