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Hemodynamics (Critical Care)
Critical Care (408)
Loma Linda University
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● Hemodynamics: movement of blood flow in the body ○ Manipulating hemodynamics -> improved patient outcome ● Invasive catheters = catheters placed in central veins OR passed through right heart chambers ● Examples of non-invasive catheters = blood pressure cuff, cheetah monitor ● Continuous monitoring = watching movement of blood + pressures being exerted into veins, arteries, chambers of heart ● Purpose of hemodynamic monitoring: ○ Early detection, identification, treatment of life-threatening conditions ○ Evaluate patients’ immediate response to medications + mechanical support ● Types of hemodynamic monitoring devices: ○ Arterial line: monitors blood pressure ■ Continuous blood pressure ■ Arterial system ○ Central venous catheter: monitors fluid volume status ■ Central vein ■ Central venous pressure ■ ScVO ○ Pulmonary artery catheter = most invasive catheter ■ Passes through right heart chamber ■ Measures: ● Cardiac output ● Cardiac output index ● Stroke volume ● Stroke volume index ● Pulmonary artery pressure ● Central venous pressure ● SVO ● Components of hemodynamic monitoring equipment: ○ Invasive catheter + high pressure tubing connecting patient to transducer ○ Transducer receives physiological signal from catheter + tubing -> converted into electrical energy ○ Flush system maintains patency of fluid filled system + catheter to prevent it from clotting off ○ Bedside monitor contains amplifier with recorder which increases volume of electrical signals + displays it as mmHg
● Nurses responsibility + role: ○ Set up system + monitor values ○ Titrate medications based on values ○ Ensure system functioning + waveforms = appropriate ○ Leveling + zeroing transducer as needed ○ Troubleshooting problems with lines + systems ● Steps to zeroing A-Line, CVP, PA catheter: ○ Ensure pressure bag @ 300 mmHg + flush solution present in bag ○ Level transducer @ phlebostatic axis (4th intercostal space OR midaxillary line) ■ Patient MUST be supine BUT head of bed can be elevated ○ Turn stopcock off to patient ○ Open transducer to air ○ Press “zero” button on monitor OR touch screen ○ Close transducer to air ○ Open stopcock to patient ○ Quick flush of line -> square wave test
Normal Range: Purpose:
Blood Pressure: -varies with site, size, age, sex -reflects pressure in systemic arterial system
CVP: -2-5 mmHg -pressure created by volume in RIGHT side of the heart -measures right ventricular preload
PAP: -20-30/5-10 mmHg -reflects pressure in pulmonary artery -should be LOW pressure
PAWP/PAOP: -5-12 mmHg -pressure created by volume in LEFT side of the heart -measures left ventricular preload
SvO2: -60-70% -indicates MIXED venous oxygenation from PULMONARY artery -helps identify oxygen in body
ScVO2: -70-80% -indicates CENTRAL venous oxygenation from RIGHT atria -helps identify oxygen in body
● FloTrac A-line: arterial line with added capability of continuous monitoring of cardiac output, cardiac index, SV, SVI, intermittent SVR ● EV 1000 Hemosphere: provides same hemodynamics as flotrac with hypotension prediction index (HPI) ○ Compatible with acumen IQ sensor aline
Pulmonary Artery Catheter Lumens:
Lumen/Port: Function:
RA: -used for HIGH volume infusion
RV: -used for LOW volume infusion
Proximal injectate: -monitor CVP -used to inject IVF for cardiac output
PA: -monitor PAP (NO infusion) -balloon in wedged position -> monitor left atrial pressures -serves as port to draw mixed venous blood gasses
Thermistor: -measures core temperature
Balloon syringe: -used for PAOP/PAWP -maximum of 1 cc of air
● External ventricular device (EVD): used to drain CSF fluid + measure ICP ○ Normal ICP = 0- ■ Greater than 20 for more than 10 minutes -> brain tissue death ○ Used for traumatic brain injury, cerebral swelling, neuro patients ○ Leveled @ brain
○ Steps to zero: ■ Level transducer @ FOM
■ Turn stopcock off to patient ■ Open transducer to air ■ Press “zero” button on monitor OR touch screen ■ Close transducer to air ■ Open stopcock to patient
Hemodynamics (Critical Care)
Course: Critical Care (408)
University: Loma Linda University
