hemodynamic monitoring basic

1. Hemodynamic monitoring
ALBERT BLESSON
MEDICAL SURGICAL NURSE

2. Hemodynamic data
 Refers to the measurement of pressure , flow and oxygen within cardiovascular
system
 Invasive and non invasive
 Systemic and pulmonary arterial pressure
 CVP
 PAWP
 Sao2
 Svo2
 Intergart with clinical data

3. Hemodynamic terminology

4. Principles of invasive pressure monitoring
 Measure systemic and pulmonary blood pressures
 Cather, Pressure tubing, Flush system, Transducer. Positions
 Explain the procedure
 Position supine an flat , elevated up to 45 degree
 Confirm the zero reference
 Observe the monitor
 End expiration

5. Swan catheter

6. zero point

7. transducer

9. Types of invasive pressure monitoring
 Arterial blood pressure
 Pulmonary artery flow directed catheter

10. Arterial blood pressure
 Acute hypertension
 Hypotension
 Respiratory failure
 Shock
 Neurological injury
 Coronary interventional procedures
 Continuous infusion of vasoactive drugs
 Frequent ABG

11. ABP
 20 g , 2 inch(5.1 cm)
 Non tapered Teflon catheter
 Peripheral line(radial, femoral)
 Suture after insertion
 Systolic and diastolic and mean blood pressure
 Measurement obtained at end expiration

12. complication
 Risk of hemorrhage---( dislodged)– luerlock connection, arterial waveform, alarm
system
 Infection(inspect the site)—(change the set ever 96 hours)
 thrombus formation (circulatory impairment)---( allen test before catheter
insertion) ---to prevent flush every 1-4 hours (pressure bag inflated to 300 mm
hg)---- flush bag delivers fluid 3 to 6 ml per hour( heparinized saline)
 Neurovascular impairment –assess hourly—cool and pale—capillary refill greater 3
seconds(tingling, pain or paresthesia)

13. Clinical indication for pulmonary artery
 ARDS
 ARF
 Cardiac tamponade
 Circulatory syndrome
 IABP
 Major trauma
 Burn injury
 MI
 Shock
 Hypotension – no response to fluid resucitations

14. Pulmonary artery flow directed catheter
 Guide ( complicated cardiac ,pulmonary and intravascular volume problems
 PAD and PAWP indicators of cardiac function
 Pressure increased in fluid overload and decrease in depletion
 PA therapeutic manipulation and to maintain CO without risk of pulmonary
edema
 PA –SWAN CATHETER
 7.5 French 43 inches (110 cms) with four and five lumens

15. catheter

17. Pulmonary catheter insertion
 Patient electrolyte( risk for ventricular dysrhythmia),Acid base balance, Oxygen, Coagulation status ( chance of
hemorrhage)
 Prepare monitor set
 Phlebostatic axis
 Supine position
 Informed consent
 Internal jugular ,subclavian, antecubital or femoral vein
 Waveform in monitor guide
 Inflate balloon (RA)—1 TO 1.5 ML
 RA - RV - PA
 Monitor ECG
 Deflate balloon when tracing PAWP
 Chest x ray
 Secure the catheter and apply dressing

18. CVP OR Right artery pressure
 Cvp measure right ventricular preload( proximal lumen)
 Internal jugular vein or subclavian vein
 Cvp measured in end expiration
 Its reflects fluid volume
 Elevated indicates right ventricular failure
 Low cvp indicates hypovolemia

19. Invasive CO
 Normal resting CO is 4 to 8 l/mt and CI is 2.2 to 4 lt/min/m2
 Varies in size
 CO and CI is decreased in shock and increased in exercise, early sepsis and fever
 Thermistor sensor in distal measure blood temperature

20. Venous oxygen saturation
 Svo2 and scvo2
 Normal – 60 to 80 %
 High – 80 to 95%
 Low less than 60%

21. Complication od PA
 Infection and sepsis( infection control protocol)
 Air embolus – injection ,balloon rupture – nurse should check for blood r air back flow in balloon port
 Risk for pulmonary infarction(balloon rupture, obstruct blood flow, thrombosis formation)
 Balloon not inflated more than 1.5 ml of air
 Balloon inflated must not be inflated for more than 4 breaths or 8-15 sec
 Thrombus ( prevent by flushing)
 Ventricular dysrhythmia ( cneck an repositioned)
0

22. Non invasive arterial oxygen monitoring
 Pulse oximetry
 ABG ANALYSIS

23. NURSES ROLE
 GENERAL APPERANCE
 LEVEL OF CONCSCIOUS
 SKIN COLOR
 TEMPERATURE
 VITAL SIGNS
 URINE OUTPUT
 PHERIPHERAL PULSE

24. THANK YOU