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Hemodynamic
monitoring non
invasive
Monika Negi
M.Sc. Nursing
(Critical care)
AIIMS 1
OBJECTIVES
At the end of the class student will able to
Define hemodynamic monitoring.
Explain the purpose of hemodynamic monitoring.
Enumerate the indication of hemodynamic monitoring.
Describe the types of hemodynamic monitoring.
Explain the method of non-invasive monitoring
including temperature, pulse , respiration, blood
pressure, capillary refill time and ECG 2
Introduction
 Hemodynamics, literally means "blood movement” through the
heart.
 Hemodynamic monitoring is the measurement of pressure, flow
and oxygenation of blood within the CVS that provides:
 Quantitative information about vascular capacity, blood
volume pump effectiveness and tissue perfusion
 Information reflecting the earliest changes in the circulatory
system that are not yet clinically detectable. 3
Purpose
• Early detection, identification, and treatment of life-
threatening conditions such as heart failure and
cardiac tamponade.
• Evaluate the patient’s immediate response to
treatment such as drugs and mechanical support.
• Evaluate the effectiveness of cardiovascular function
such as cardiac output and index.
4
Indications
All types of shock
e.g. cardiogenic , hypovolemic, distributive and obstructive
Decreased cardiac output
e.g. dehydration , haemorrhage, G.I. bleed, burns, or post
surgery
Any deficient or loss of cardiac function
e.g. acute MI, CHF, cardiomyopathy
5
Types of monitoring
• Continous v/s intermittent
• Invasive v/s non invasive
6
Types of hemodynamic
monitoring
Temperature
Respiratory rate
Heart rate and Pulse rate
Non invasive blood pressure
(NIBP)
SpO2
Capillary refill time
ECG
7
 Non invasive
Continue…
Invasive
Central venous pressure(CVP)
Pulmonary artery pressure(PAP)
Intra arterial blood pressure cardiac output(CO)
Arteriovenous gas analysis(ABG)
8
Temperature monitoring
9
Indication of temperature
monitoring
• Fever
• Hyperthermia
• Heatstroke
• Hypothermia
• Frostbite
• Heat exhaustion
• Assessment of hemodynamic status 10
Route of temperature
monitoring
• Oral
• Axilla
• Rectum
• Tympanic membrane
• Skin
• Temporal artery
11
Acceptable range for adult
Temperature range 36-38 deg. C (96.8- 100.4 deg.F)
Average oral/tympanic 36-38deg. C (96.8-98.6 deg. F)
Average axillary 36.5deg. C (97.7deg. F)
Average rectal 37deg. C (98.6 deg. F)
Average tympanic 37.5 deg. C (99.5deg. F)
12
Temperature monitoring devices
1. Electronic thermometer
a) For oral and rectal monitoring
• predictive temperature: 4 sec
• Standard temperature :3 min
13
14
b)Tympanic membrane thermometer
Timing: within seconds
c)Temporal artery thermometer
timing: within seconds
15
d) Digital thermometer
timing: 3 min
e)Infrared thermometer
timing: within seconds
Chemical dot thermometer
16
Types
1.Single use
2.Reusable
Version
1.Celsius version
50 dots each represent temp. increment of 0.1 deg.
Celsius over a range of 35.5 -40.4 deg. Celsius
2.Fahrenheit version
45 dots each represent temp. increment of 0.2 deg. F
over a range of 96 -104.8 deg. F
COLOUR
change within
60 sec.
Pulse rate
17
Factors influencing pulse rate
Sr.
no.
Factors Increase pulse rate Decrease pulse rate
1. Exercise Short term excercise Long term exercise
2. Temperature Hyperthermia hypothermia
3. Emotion Acute pain , anxiety Unrelieved pain , relaxation
4. Drug Positive chronotropic Negative chronotropic
5. Hemorrhage Loss of blood
6. Postural changes Standing or sitting Lying down
7. Pulmonary condition Asthma ,COPD
18
Pulse point on the body
19
Temporal
Apical
Method of assessing pulse
• Palpation
• Auscultation
• ECG
• Spo2 probe
20
Characters of pulse
• Rate
• Rhythm
• Strength
• Equality
• Force
• Tension
• Form
21
Patterns of pulse
• Dicrotic pulse
• Pulsus alternans
• Pulsus bigeminus
• Pulsus bisferiens
• Pulsus tardus et parvus
• Pulsus paradoxus
22
23
Factors influencing character of
respiration
• Exercise
• Acute pain
• Anxiety
• Smoking
• Body position
• Medication
• Neurological injury
• Haemoglobin function
24
Method of assessing respiration
25
Characteristics of respiration
• Rate
• Depth
• rhythm
26
Alternation in breathing pattern
• Bradypnoea
• Tachypnoea
• Apnoea
• Hyperventilation
• Hypoventilation
• Cheyne stokes respiration
• Kussmaul’s respiration
• Biot’s respiration
• Paradoxical respiration
27
Pulse oximetry
28
Purpose
• It is used to detect sudden changes in saturation of
oxygen
Unreliable the value when
• Cardiac arrest
• Shock
• Sepsis
29
Sites of placing probe
30
Mechanism
31
It works on the principle of spectrometry
Factors affecting determination
of Spo2
Interference with light transmission
• Outside light sources
• Carbon monooxide
• Patient motion
• Jaundice
• Intravacular dyes
• Nail polish, artificial nail
• Dark skin pigment 32
Interference with arterial
pulsation
• Peripheral vascular disease
• Hypotension
• Hypothermia
• Vasoconstrictors
• Peripheral edema
33
Blood pressure monitoring
34
35
Factors influencing blood
pressures
36
•Age
•Stress
•Ethnicity
•Gender
•Daily variation
•Medication
•Activity
•Weight
•Smoking
Types of BP monitors
37
38
Position for measuring blood pressure
39
Sites for measuring BP
40
41
42
90-99
> Or =100
80-89
Capillary refill test
43
Electrocardiogram
44
Types of ECG machines
45
46
47
3 LEAD ECG
5 LEAD ECG
ECG Graph
48
Normal sinus rhythm
49
V and A rate : 60 to 100
V and A rhythm :regular
QRS shape and duration : normal
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1
Sinus bradycardia
50
V and A rate :LESS THAN 60
V and A rhythm :regular
QRS shape and duration : normal
P WAVE : ALWAYS IN FRONT of QRS
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1
Sinus tachycardia
51
V and A rate :greater THAN 100 but less than 120
V and A rhythm :regular
QRS shape and duration : normal
P WAVE : ALWAYS IN FRONT of QRS
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1
Atrial fibrillation and atrial
flutter
52
V and A rate : A rate b/w 300- 600 V rate b/w 120-200
V and A rhythm :highly irregular
QRS shape and duration : normal may be abnormal
P WAVE : non discernable called F wave
PR interval :difficult to determine
P:QRSmany :1
Ventricular tachycardia
53
V and A rate : V rate b/w 100-200 and atrial rate depend upon underlying rhythm
V and A rhythm :usually regular
QRS shape and duration :abnormal shape 0.12sec
P WAVE : difficult to detect
PR interval :difficult to determine
P:QRSmany :more QRS then P
Ventricular fibrillation
54
V and A rate : V > 300
V and A rhythm :extremely irregular
QRS shape and duration :irregular ,undulating waves without recognizable QRS complex
ST Segment changes
55
56
Nursing management
57
Nursing responsibility in invasive
hemodynamic monitoring
• Explain procedure to the patient.
• Inspection of the site of application for any kind of skin
irritation.
• Immediate reporting and appropriate action in case of
any deviation from normal.
• Documentation for vital sign
• Recording of event
58
Conclusion
Non invasive hemodynamic monitoring is a save
detection method of hemodynamic changes. It is
very important to measure these changes in order to
prevent any complications. Nurses play a key role in
detecting these changes.
59
Summary
60
Hemodynamic monitoring
Purpose indication
Types
Non-invasive method
•Temperature
•Pulse
•respiration
•Blood pressure
•Capillary refill
•ECG
temp
61
62

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Hemodynamic monitoring non invasive

Notas do Editor

  1. V and A rate : 60 to 100 V and A rhythm :regular QRS shape and duration : normal PR interval : Consistent interval between 0.12 and 0.20 P:QRS : 1:1
  2. V and A rate :LESS THAN 60 V and A rhythm :regular QRS shape and duration : normal P WAVE : ALWAYS IN FRONT of QRS PR interval : Consistent interval between 0.12 and 0.20 P:QRS : 1:1
  3. V and A rate :greater THAN 100 but less than 120 V and A rhythm :regular QRS shape and duration : normal P WAVE : ALWAYS IN FRONT of QRS PR interval : Consistent interval between 0.12 and 0.20 P:QRS : 1:1
  4. V and A rate : A rate b/w 300- 600 V rate b/w 120-200 V and A rhythm :highly irregular QRS shape and duration : normal may be abnormal P WAVE : non discrinable called F wave PR interval :difficult to determine P:QRSmany :1 V and A rate : A rate b/w 250- 400 V rate b/w 75-150 V and A rhythm :regular may be irregular QRS shape and duration : usually normal may be abnormal P WAVE : saw tooth shape called F wave PR interval :difficult to determine P:QRS : 2:1,3:1,4:1
  5. V and A rate : V rate b/w 100-200 and atrial rate depend upon underlying rthythm V and A rhythm :usually regular QRS shape and duration :abnormal shape 0.12sec P WAVE : difficult to detect PR interval :difficult to determine P:QRSmany :more qrs then p
  6. V and A rate : V > 300 V and A rhythm :extremely irregular QRS shape and duration :irregular ,undulating waves without recognizable QRS complex