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HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)

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Presentation on theme: "HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)"— Presentation transcript:

1 HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)

2 Equipment Needed for Hemodynamic Monitoring Transducer: an instrument that senses physiological events & transforms them into electrical signs Amplifier: connects to transducer and an electrical cable;filters out interference so signal can be displayed Monitors: provides display of original signal Catheter, tubing flush system (single or double): pressure bag is 500cc Normal Saline with 10cc of 100u/ml of heparin; delivers continuous cc/hr to keep line open; catheter may be arterial or venous

3 Monitoring Hemodynamic Measurements Arterial – used for unstable BP or frequent ABG’s or labs Controversial regarding accuracy Inserted by MD, RT, or Anesthesia Inserted into any artery Waveform: peak represents SBP and Ventricular contraction, lowest point reflects peripheral resistance & diacrotic notch is on the downward stroke & results from aortic valve closure MAP – mean arterial pressure represents perfusion pressure in aorta and branches; SBP-DBP/3 + DBP = MAP Nursing considerations Complications

4 Central Venous Pressure – represents blood return to the heart; abnormalities usually secondary to altered venous tone and / or blood volume Inserted by MD under sterile conditions Normal value is 0-8 mm Hg Increase in blood volume = increase in CVP (vice versa) Triple Lumen Catheter (TLC); distal port on TCL and proximal on Swan Ganz catheter Measured at end of expiration: ventilated patients lowest part of waveform and vice versa for spontaneous breathing

5 Pulmonary Artery Catheter or Swan Ganz Catheter – allows monitoring of Left Ventricular function Various ports – proximal (cardiac output), distal (PA), balloon (wedge or PCWP), RV (pacer port) & temp (core blood temp) Inserted by MD under sterile conditions at the brachial, subclavian, internal jugular or external jugular veins All measurements done at end of expiration

6 What can we monitor with the Swan Ganz Catheter? PAP – pulmonary artery pressure; @ 25/10 with average 15 PCWP – pulmonary catheter wedge pressure; @ 6-12; use of DPAP if balloon not working Cardiac Output – can be measured intermittently or continuously -- injectate is D5W or NS @ 10cc --errors in CO -- 3 values averaged (within 10%) of each other -- CO = 4-8 L/min -- CI or cardiac index = CO/BSA usually greater than 2

7 Mixed Venous Oxygenation (SVO2) – allows clinician to look at overall picture of O2 used by the body organs CVP – central venous pressure 0-8mmHg SVR – systemic vascular resistance- measures the opposition to blood flow exerted by blood vessels; 800-1200 normal value Formula: SVR= MAP-CVP x 80/ CO PVR – pulmonary vascular resistance Formula: PVR= MAP-PCWP x 80/CO

8 Volume Effects on Hemodynamic Monitoring What is the difference between intracellular and extracellular volume? 1.Arterial Pressure 2.Central Venous Pressure 3.PAP/PCWP 4.Cardiac Output 5.SVR

9 Pharmacological Agents Used in Hemodynamic Monitoring 1.Arterial Pressure Dopamine > or= 5 mcg/kg/min up to 20mcg/kg Epinephrine mcg/min Neosenephrine mcg/min Levophed or norepinephrine mcg/min 2.CVP Volume controlled 3.PCWP/PAP –increase CO by decreasing PAP and PCWP Dobutamine 5-20 mcg/kg/min Natrecor.001mcg/kg/min

10 5.Cardiac Output Dobutamine and Natrecor Must be sure enough volume on board to gain desired effect 6.SVR Nipride mcg/kg/min used to decrease SVR and increase CO Cardene 5-10mg/hr

11 Inotropic Agent Calculations  Difference between positive and negative inotropic drugs?  Dosing charts: CONCENTRATION of drug must match in order to use charts  Pharmacy directions for drug adminstration: always DOUBLE-CHECK!  Fudge Factors: a way of calculating dosages and rates

12 Fudge Factors  Know the concentration of drug ordered  Know the patient’s weight in kilograms  Know the volume of dilution  Know correct dosage administration for drug ordered  Remember constants

13 Fudge Factor Formula  How is the drug run? mcg/min, mcg/kg/min, mcg/kg/hour, mg/min  Fill in the necessary formula componentsmg x 1000 volume x kg x 60 volume x 60 mg x 1000 mg volume x kgvolume x 60


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