2. 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
3. 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
4. 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
5. 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
12. 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
13. Temperature monitoring devices
1. Electronic thermometer
a) For oral and rectal monitoring
• predictive temperature: 4 sec
• Standard temperature :3 min
13
16. 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.
49. 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
50. 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
51. 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
52. 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
53. 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
54. 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
58. 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
59. 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
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
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
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
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
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
V and A rate : V > 300
V and A rhythm :extremely irregular
QRS shape and duration :irregular ,undulating waves without recognizable QRS complex