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Hemodynamic Monitoring

Through this note I hope you get information about hemodynamic monitoring

Course

Bsc nursing (blaw 213)

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University

Kerala University of Health Sciences

Academic year: 2021/2022

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Devu G Nath

Kerala University of Health Sciences

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HEMODYNAMIC

MONITORING

INTRODUCTIONINTRODUCTION

Critically ill patients require continuos assessment of their cardiovascular system to diagnose and manage their complex medical conditions is most commonly achieved by the use of direct pressure monitoring systems,often refered to as

hemodynamic monitoring function is the main focus of

hemodynamic studies. Hemodynamic pressure monitoring

provides information about blood volume , fluid balance and how

well the heart is pumping. Nurses are responsible for the

collection measurement and interpretation of these dynamic

patient status parameters.

PURPOSESPURPOSES

 Early detection, identification and

treatment of life threatening conditions

such as heart failure and cardiac

tamponade.

 EvaluateEvaluate thethe patient’spatient’s immediateimmediate responseresponse

to treatment such as drugs and mechanical

support.

 Evaluate the effectiveness of

cardiovascular function such as cardiac

output and index.

INDICATIONSINDICATIONS

 Any deficits or loss of cardiac function: such as myocardial infarction, congestive heart failure, cardiomyopathy.

 All types of shock; cardiogenic shock, neurogenic shock or anaphylactic shock.

 Decreased urine output from dehydration, hemorrhage. G bleed, burns or surgery.

HEMODYNAMICHEMODYNAMICMONITERMONITER

 Setup pressure lines and transducers. Level pressureflush monitoring system and transducers to the phlebostaticaxis.

 Connect tubings to patient when patient is ready to flush the swann.

 While floating the swann, observe for ventricular ectopy on the monitor.

 AfterAfterswannswannisis ininplace,place,assistassistwithwithcleanupcleanup andand letletpatientpatient know procedure is complete.

 Obtain all the values. For cardiac output inject 10mls of D5w after pushing the startbutton.

 Perform hemocalculations.

 Document findings in ICU flow sheet.

PHLEBOSTATIPHLEBOSTATICCAXISAXIS

DETERMINANTSDETERMINANTS OFOF CARDIACCARDIAC

PERFORMNACE

 PRELOAD: preload is the volume with

in the ventricle at the end of diastole.

 AFTERLOAD : it refers to the forces

opposing ventricular ejection.

 CONTRACTILITY: it describes the

strength of contraction

METHODMETHODSS OOFF HEMODYNAMICHEMODYNAMIC

MONITORING

1 BLOOD PRESSURE

a)Non Invasive

b)Intrab)Intra arterial blood pressure arterial blood pressure

measurement

2 VENOUS PRESSURE

3 ARTERY CATHETER

PRESSURE MONITORING

DIRECTDIRECT IINTRANTRAARTERIALARTERIAL BP BP

MONITORINGMONITORING

 Intra-arterial BP monitoring is used to

obtain direct and continuous BP

measurements in critically ill patients who

havehave severesevere hypertensionhypertension oror hypotensionhypotension

PROCEDUREPROCEDURE

 Once an arterial site is selected (radial, brachial, femoral, or dorsalis pedis), collateral circulation to the area must be confirmed before the catheter is placed. This is a safety precaution to prevent compromised arterial perfusion to the area distaldistal toto thethe arterialarterial cathetercatheter insertioninsertion sitesite.. IfIf no collateral circulation exists and the cannulated artery became occluded, ischemia and infarction of the area distal to that artery could occur.

 Collateral circulation to the hand can be checked by the Allentest

COMPLICATIONSCOMPLICATIONS

 Local destruction with distal ischemia  external hemorrhage  massive ecchymosis  dissectiondissection  air embolism  blood loss  pain  arteriospasm and  infection.

NURSINGNURSING INTERVENTIONSINTERVENTIONS

 Before insertion of a catheter, the site is prepared

by shaving if necessary and by cleansing with an

antiseptic solution. A local anesthetic may be

used.

 OnceOnce thethe arterialarterial cathetercatheter isis inserted,inserted, itit isis

secured and a dry, sterile dressing is applied.

 The site is inspected daily for signs of

infection. The dressing and pressure monitoring

system or water manometer are changed

according to hospital policy.

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