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Hemodynamic Monitoring
Medical Surgical 1 (MEDSRG101)
Chamberlain University
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Hemodynamic Monitoring
Chapter 65 Hemodynamic Monitoring Measurement of pressure, flow, and oxygenation within cardiovascular system Assesses heart function, fluid balance, and effects of drugs on CO Hemodynamic Monitoring Invasive and noninvasive measurements Systemic Central venous pressure (CVP) Pulmonary artery wedge pressure (PAWP) Hemodynamic Monitoring Invasive and noninvasive measurements O 2 saturation of arterial blood (SaO 2 ) Mixed venous oxygenation saturation (SvO 2 ) Hemodynamic Monitoring Terminology Systemic vascular resistance (SVR) and pulmonary vascular resistance (PVR) Opposition to blood flow by systemic and pulmonary vasculature Preload, afterload, and contractility determine SV Hemodynamic Monitoring Terminology Preload Volume of blood within ventricle at end of diastole PAWP: reflects left ventricular end-diastolic pressure (6-12 mmhg) CVP: reflects right ventricular end-diastolic pressure (2-8 mmhg) Hemodynamic Monitoring Terminology Afterload Forces opposing ventricular ejection SVR and arterial pressure indices of left ventricular afterload PVR and pulmonary arterial pressure indices of right ventricular afterload Hemodynamic Monitoring Terminology Mean Arterial Pressure (MAP) (Diastolic x 2) + Systolic / 3 Normal is 65-105 mmhg
Hemodynamic Monitoring
A 46-year-old male was found unconscious outside Coors field and brought to the emergency department by EMS. On arrival, the patient's blood pressure is 70/55 mmHg, HR 120, jugular
veins are flat, dry mucosal membranes and decreased skin turgor, capillary refill time is 6 seconds. The patient face is flushed, and skin is warm to touch.
Mean Arterial Pressure – 50 mmhg Pulmonary capillary wedge pressure (PAWP) – 4 mmhg; Central Venous Pressure (CVP) – 1 mmhg. Hemodynamic Monitoring
A 71-year-old woman presents to the ER endorsing 2-3 days of increased dyspnea. Her past medical history is notable for hypertension, heart failure with reduced ejection fraction. She reports recent dietary indiscretions, consuming salty foods, and medication noncompliance. She states sleeping with 3+ pillows to prop herself up. Vital signs are as follows: T 98, HR 87, BP 160/78, RR 24, and SpO2 of 89% on room air. She has labored breathing. Pulmonary examination reveals bilateral crackles, and she has 2+ edema in her lower extremities. Echo: EF 28% BNP: 1200 pg /ml Mean Arterial Pressure – 100 mmhg Pulmonary Arterial Wedge Pressure (PAWP) – 14 mmhg Central Venous Pressure (CVP) – 10 mmhg
Components of Pressure Monitoring System Principles of Invasive Pressure Monitoring Equipment must be referenced and zero balanced to environment Dynamic response characteristics optimized Referencing: positioning transducer at level of atria of heart or phlebostatic axis Identification of the Phlebostatic Axis Principles of Invasive Pressure Monitoring Zeroing : confirms that when pressure within system is zero, monitor reads zero With initial setup and periodically thereafter Dynamic Response Test (Square Wave Test) Types of Invasive Pressure Monitoring Arterial blood pressure monitoring Various indications when continuous BP measurements useful Non-tapered Teflon catheter into peripheral artery Suture in place Immobilize insertion site
Types of Invasive Pressure Monitoring Arterial blood pressure monitoring MAP – Mean Arterial Pressure Normal is 65- MAP tells us about blood flow to organ and tissues (Diastolic x 2) + (Systolic) divided by 3
PA measures mixed venous oxygen saturation (SvO 2 ) Determines adequacy of tissue oxygenation Venous Oxygen Saturation SvO 2 /ScvO 2 reflect balance between oxygenation of arterial blood, tissue perfusion, and tissue oxygen consumption. Assess hemodynamic status and response to treatment/activity Normal 60%–80% Venous Oxygen Saturation ↓ In SvO 2 /ScvO 2 ↓ Arterial oxygenation Low CO Low hemoglobin level Acidosis ↑ Oxygen consumption or extraction Venous Oxygen Saturation ↑ In SvO 2 /ScvO 2 May indicate clinical improvement Hypometabolic rates Alkalosis A 56-year-old man presents to the emergency department after being stabbed multiple times. Paramedics report extensive blood loss at the scene where he was found. Due to his Glasgow Coma Scale score of 5, an endotracheal airway and large-bore access are secured prior to arrival. He is aggressively resuscitated with a massive transfusion protocol as the operating room is prepared for an exploratory laparotomy. An arterial line and Swan Ganz catheter are obtained. His blood pressure is 50/40 mmHg, Pulse is 128/min, RR controlled at 20/min on mechanical ventilation. SvO2 results are 39%. ABG’s Ph: 7, PCO2: 35, HC03: 19, SaO2 of 100%
Complications with PA Catheters Air embolus (e., disconnection) Monitor for balloon integrity Luer-Lok connections; alarms on Infection and sepsis Asepsis for insertion and maintenance Change flush bag, pressure tubing, transducer, and stopcock every 96 hours Complications with PA Catheters Pulmonary infarction or PA rupture Do not inflate balloon with >1 mL Monitor waveforms continuously Maintain continuous flush system Ventricular dysrhythmias Monitor during insertion and removal Also for migration of PA catheter
Nursing Management Assess end organ perfusion General appearance Level of consciousness Skin color/temperature Peripheral pulses Urine output Vital signs
Nursing Management Correlate end organ perfusion with data obtained from biotechnology (e., ECG; arterial, CVP, PA, and PAWP pressures; SvO 2 /ScvO 2 ) Monitor trends
Hemodynamic Monitoring
Course: Medical Surgical 1 (MEDSRG101)
University: Chamberlain University
