Hemodynamic Monitoring and Devices

How do you calculate the Mean Arterial Pressure (MAP)?

MAP = SBP + (2 x DBP) / 3

The average pressure maintained within the arterial system of the body — normal: 70-100

Describe Pulse Pressure (PP)

Difference between the systolic and diastolic blood pressure

PP = SBP - DBP

Normal PP: 30-50 mmHg

Pulse pressure typically becomes more narrow with lower blood pressure (ex. 90/70, PP =20)

Arterial Pressure Monitoring

Displays waveform and constant blood pressure readings — easier way to visualize trends (radial artery placement is most common)

What is the correct placement of the arterial pressure monitoring device?

Transducer placed at the 4th intercostal space at the midaxillary line at the level of the right atrium

Central Venous Pressure (CVP)

Measures preload and provides a measurement of fluid status

Normal: 2-8 mmHg // Expected: 8-12 mmHg

What factors could cause a decrease in central venous pressure?

Hypovolemia, blood loss > 10%, dilation of the vena cava, or decreased intrathoracic pressure

What factors could cause a increase in central venous pressure?

Decreased cardiac contractility, dysrhythmia, or abnormal functioning of cardiac valves

What is the correct placement of the central venous pressure (CVP) device?

Transducer inserted into the jugular or subclavian vein then advanced into the superior vena cava at the entrance of the right atrium. The pressure is measured by the transducer or amplifier that is placed at the level of the tricuspid valve

Pulmonary Artery Catheter (or Swan-Ganz Catheter)

Allows monitoring of clients with cardiogenic shock, pulmonary hypertension, and unexplained dyspnea

• Right-sided cardiac catheter chamber filling pressures

• Cardiac valves

• Intracardiac shunts

• Cardiac output

• Vascular resistance

What are some best practices for care of hemodynamic lines?

• Use sterile, all-inclusive kit to reduce risk of contamination

• Perform hand hygiene

• Dressing changes - chlorhexidine during dressing changes, change transparent dressing every 7 days, change gauze dressing every 48 hours, and change when soiled

• Access line as little as possible to reduce risk of contamination

• If assessing a hub, scrub with disinfectant for 30 seconds

• Change central line tubing up to every 96 hours with strict sterile technique

What disinfectant chemical is used for central line dressing changes?

Chlorhexidine

How often should transparent dressing be changed for central line dressings?

Every 7 days unless visibly soiled

How long should you scrub the hub of a central line before accessing?

30 seconds

How often should the central line tubing be changed? What type of technique should be used?

Every 96 hours with strict sterile technique

Continuous Renal Replacement Therapy (CRRT)

Blood purification therapy that allows blood to pass through a unique filter that remove fluid and toxins. Dialyzes more slowly in hemodynamically unstable patient over a 24 hour period

Intra-Aortic Balloon Pump (IABP)

Temporary treatment in cardiogenic shock by increased coronary artery blood flow and perfusion to organs (decreased workload on the heart). The balloon inflates during diastole and deflates during systole.

What is the correct placement of the intra-aortic balloon pump?

Balloon inserted into the femoral artery and lying distally into the left subclavian artery and proximal portion ending above the renal artery