1. 5/24/2015 1 HEMODYNAMIC MONITORING

2. OBJECTIVE 5/24/2015 2 1. Describe the three attributes of circulating blood and their relationships. 2. Identify types of clients in which hemodynamic monitoring would be indicated. 3. Describe the types of catheters used for hemodynamic monitoring. 4. Discuss the normal and abnormal values obtained through hemodynamic monitoring as they relate to specific client situations. 5. List the potential complications in use of hemodynamic monitoring devices. 6. Explain nursing responsibilities when caring for patient on hemodynamic monitoring. 7. Describe the procedure for setting up a hemodynamic circuit.

3. HEMODYNAMIC MONITORING 5/24/2015 3 DEFINITION: Using invasive technology to provide quantitative information about vascular capacity, blood volume; pump effectiveness, and tissue perfusion

4. HEMODYNAMIC MONITORING 5/24/2015 4 ATTRIBUTES OF CIRCULATING BLOOD: 1. PRESSURE 2. RESISTANCE 3. Flow

5. HEMODYNAMIC MONITORING 5/24/2015 5 TYPES OF CATHETERS USED FOR HEMODYNAMIC MONITORING: 1. Pulmonary Artery Catheter (swan ganz) 2. Arterial Pressure Catheters 3. Central Venous Pressure or CVP monitoring

6. HEMODYNAMIC MONITORING 5/24/2015 6 INDICATIONS FOR HEMODYNAMIC MONITORING: 1. Potential or actual alteration in CO 2. Potential or actual alteration in fluid volume

7. HEMODYNAMIC MONITORING 5/24/2015 7 PULMONARY ARTERY MONITORING EQUIPMENT 1. Invasive catheter (swan ganz) 2. Transducer 3. Amplifier/recorder

8. HEMODYNAMIC MONITORING 5/24/2015 8 SWAN GANZ CATHETER a. Distal Lumen: the PA (pulmonary artery) b. Proximal Lumen: (CVP port) c. Inflation Balloon D. Thermostat Lumen e. Additional Lumens * VIP - venous infusion port * Pacing Port-

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10. HEMODYNAMIC MONITORING 5/24/2015 10 Assessment Data, Pressures, Waveforms of the swan ganz catheter a. RAP or CVP b. PAP - c. PCWP (PAWP) d. Waveforms: RAP, RVP, PAP, PCWP e. Using Pressures to Calculate Other Hemodynamic Variables * CO, CI, MAP, SVR, PVR

11. HEMODYNAMIC MONITORING 5/24/2015 11 NURSING RESPONSIBILITIES 1. Pre-Insertion: a. Patient & significant others teaching. b. Thorough baseline assessment c. Equipment set-up d. Positioning of the client e. Equipment check (calibration, zero etc.)

12. HEMODYNAMIC MONITORING 5/24/2015 12 NURSING RESPONSIBILITIES 2. Insertion, (patient is often awake for the procedure) a. Collaboration b. Assist with equipment preparation c. Monitor patients response to treatment e. Recording

13. HEMODYNAMIC MONITORING 5/24/2015 13 NURSING RESPONSIBILITIES 3. Post-Insertion a. Chest X-ray for placemen b. Sterile OCCLUSIVE dressing, stabilization of the catheter c. Patient comfort d. Assess and document pressures/data e. Catheter maintenance f. Monitor patients response

14. HEMODYNAMIC MONITORING 5/24/2015 14 NURSING RESPONSIBILITIES Maintenance of the System: a. Label and date lines, change tubing as per unit policy b. Maintain & change dressing c. Alert for waveform and pressure changes d. Maintain pressure/pressure bag e. Keep balloon deflated between PCWP readings f. Collaboration and communication with physician g. Remember to care for the patient as well as your equipment

15. HEMODYNAMIC MONITORING 5/24/2015 15 POTENTIAL COMPLICATIONS 1. Dysrhythmias 2. Infection 3. Pneumothorax 4. Pulmonary infarction 5. Balloon rupture and air embolism 6. Pulmonary artery rupture 7. Endocarditis

16. HEMODYNAMIC MONITORING 5/24/2015 16 ARTERIAL PRESSURE MONITORING: 1. Indications 2. Assessment data: * MAP = (diastolic x 2)+(systolic) 3 * MAP - ICP = CPP

17. HEMODYNAMIC MONITORING 5/24/2015 17 ARTERIAL PRESSURE MONITORING: 3. Arterial Waveform a. Aortic valve opens and blood is ejected from LV and is recorded as an increase in pressure b. Highest point represents systole c. Lowest point is diastolic pressure

18. HEMODYNAMIC MONITORING 5/24/2015 18 ARTERIAL PRESSURE MONITORING: 4. Nursing Responsibilities 5. Potential Complications: a. Thrombosis at catheter tip b. Infection c. Bleeding d. Loss of flow distal to extremity

19. Nursing Responsibilities 5/24/2015 19 Prepare the setup and the circuits Assist in the procedure Caring for equipments as well as for the patient. Calibration Obtaining the readings Interpreting the results and informing the physician Providing the suitable management Documenting

20. 5/24/2015 20 Swan Ganz Cathetarization

21. PROCEDURE FOR SETTING UP A HOMODYNAMIC CIRCUIT 5/24/2015 21 Equipment Required: 1. 2 single transducer kit 2. 2 Pressure bags 3. 2 500 mL bag of.9 NaCl with1,000 units of heparin 4. 2 transducer clamp 5. 2 pressure cable connected to Protocol monitor

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