HEMODYNAMIC MONITORING

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HEMODYNAMIC MONITORING
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OBJECTIVE

• 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.

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HEMODYNAMIC
MONITORING

• DEFINITION
• Using invasive technology to provide
• quantitative information about vascular
  capacity, blood volume pump
• effectiveness, and tissue perfusion

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HEMODYNAMIC MONITORING

• ATTRIBUTES OF CIRCULATING BLOOD 
• 1. PRESSURE
• 2. RESISTANCE
• 3. Flow

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HEMODYNAMIC MONITORING

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

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HEMODYNAMIC MONITORING

• INDICATIONS FOR HEMODYNAMIC MONITORING
• 1. Potential or actual alteration in CO
• 2. Potential or actual alteration in fluid
  volume 

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HEMODYNAMIC MONITORING

• PULMONARY ARTERY MONITORING EQUIPMENT
• 1. Invasive catheter (swan ganz)
• 2. Transducer
• 3. Amplifier/recorder

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HEMODYNAMIC MONITORING

• 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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HEMODYNAMIC MONITORING

• 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 

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HEMODYNAMIC MONITORING

• NURSING RESPONSIBILITIES
• 1. Pre-Insertion 
• a. Patient significant others teaching.
• b. Thorough baseline assessmentc. Equipment
  set-upd. Positioning of the cliente. Equipment
  check (calibration, zero
• etc.) 

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HEMODYNAMIC MONITORING

• 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 

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HEMODYNAMIC MONITORING

• NURSING RESPONSIBILITIES
• 3. Post-Insertion 
• Chest X-ray for placemen
• Sterile OCCLUSIVE dressing, stabilization of the
  catheter
• Patient comfort
• Assess and document pressures/data
• Catheter maintenance
• Monitor patients response

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HEMODYNAMIC MONITORING

• 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
• physiciang. Remember to care for the
  patient as well as
• your equipment

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HEMODYNAMIC MONITORING

• POTENTIAL COMPLICATIONS 
• 1. Dysrhythmias2. Infection 3.
  Pneumothorax4. Pulmonary infarction 5. Balloon
  rupture and air embolism6. Pulmonary artery
  rupture
• 7. Endocarditis  

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HEMODYNAMIC MONITORING

• ARTERIAL PRESSURE MONITORING
• 1. Indications
• 2. Assessment data  
• MAP (diastolic x 2)(systolic)
• 3
• MAP - ICP CPP 

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HEMODYNAMIC MONITORING

• 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 

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HEMODYNAMIC MONITORING

• 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
•  

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Nursing Responsibilities

• 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

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Swan Ganz Cathetarization
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PROCEDURE FOR SETTING UP A HOMODYNAMIC CIRCUIT

• 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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