During transport you note a PA-cath waveform consistent with a certain position. What action should you take?

• A. Pull back on the PA-cath until you see a CVP/RA waveform
• B. Advance the catheter
• C. Remove the catheter
• D. Flush the line and reassess

Answer: (A)

Recognize catheter position by the waveform at the distal tip. A PA catheter should show a pulmonary artery tracing when in the PA, but if you’re seeing a tracing consistent with the right atrium (CVP/RA waveform), it means the tip is too proximal and in the RA or a central vein. The safest immediate step is to withdraw the catheter slightly until the tracing changes to a CVP/RA waveform. This confirms you’ve moved away from the RA and into a safer, more controllable position for reassessment. Once you’ve re-established the CVP waveform, you can re-evaluate and consider advancing again if appropriate, under continuous monitoring. Flushing won’t correct misplacement, and advancing further or removing the catheter without verifying position risks injury.