Hemodynamic Monitoring

Hemodynamic Monitoring

PACU

  • Monitoring of blood flow & pressures within the body

  • Balance between blood flow, resistance & pressures within the body

  • Focuses on circulation, perfusion & tissue oxygenation

Hemodynamic Monitoring: Key Terms

  • Stroke Volume (SV)- amount of blood leaving the left ventricle (LV) during each contraction. Normal: 60-100 mL/beat

  • Cardiac Output (CO)- amount of blood leaving the LV per minute. (HR x SV) Normal: 4-6 L/min. Essential for adequate tissue oxygenation

  • Cardiac Index (CI)- is the CO/ sq, meter of body surface area. More accurate than CO. Normal 2.5-3 L L/min.

  • Ejection Fraction (EF)- % of blood ejected from the ventricles with each beat. Normal: 55-70%

  • Contractility- force of contraction. Frank-Starling law: bigger the stretch = bigger the contraction

  • Preload- volume of blood in ventricles at the end of diastole

  • Afterload- the resistance/pressure the ventricle must overcome to eject blood during systole

Importance of Hemodynamic Monitoring

  • Aids in diagnosis

  • Assists in guiding therapies & treatments

  • Evaluates patient response to current therapies & treatments

  • Indications:

    • asses heart function, fluid balance, effects of drugs that affect cardiac output

    • Monitoring perfusion, especially in situations with unstable BP

  • Types: non-invasive & invasive

Non-invasive Monitoring

  • Continuous blood pressure (dynamap), pulse ox (continuous SpO2/noninvasive arterial oxygen monitoring, capillary refill, pulses (arterial & peripheral)

  • Transesophageal ultrasound (TEE)

Invasive Hemodynamic Monitoring

  • Invasive methods include: arterial lines, jugular central lines, pulmonary artery catheters (AKA Swan Ganz) and Pressure bag & transducer

  • Pressure bag & transducer

    • NSS bag, pressure device, tubing w/ transducer, pole mount

    • Transducer at Phlebostatic Axis

    • Zeroing & flushing

  • Arterial lines (A-lines)

    • Continuous BP monitoring

    • Via artery: usually radical

    • Allen’s test

    • Blood access: labs & ABGs

    • Indications: hypotension, hypertension, resp. failure, shock, during surgery admin of vasoactive drugs

    • Risks: hemorrhage, infection, thrombus, NV impairment

  • look at pics

A-lines Waveform

EKG Aline

Subclavian Central Venous Catheter (CVC)

  • Central Venous Pressure (CVP)

    • Central line cath

    • Triple lumen: can infuse blood, IV fluids & meds

    • Measure CVP/right atrium pressure

    • Normal 2-6 mmHg

      • Low readings indicate hypovolemia

      • High readings indicate fluid overload

    • Possible complications: infection (CLABSI). pneumothorax, air emboli, bleeding


Aline & CVP Waveforms

Pulmonary Artery Catheter/Swan Ganz

  • Used for complicated cardiac, pulmonary intravascular volume problems

  • Ports for fluids, withdrawal of blood for labs, to measure heart pressures & cardiac output & monitor core temp

  • Pulmonary capillary wedge pressure (PCWP) Normal 6-12 mmHg

  • PCWP increased with fluid overload & HF

  • PCWP-

    • balloon inflated & floated through the heart, it wedges into the pulm artery & blood flow is temp. stopped

    • measures the pressures in front of the balloon, the left side of the heart

    • Increased pressures can indicate: LV failure, ischemia, pericarditis, mitral valve disease, fluid overload

    • Decreased pressures can indicate: hypovolemia, shock, vasodilating drugs

Nursing Management in Hemodynamic Monitoring

  • Assess patient baseline and as needed

    • General appearance, LOC, skin color/temp, vitals, resp status, peripheral circulation, urine output, changes in pt condition and/or numbers

  • Monitor & compare invasive measures with non-invasive

  • Monitor sites of invasive lines for:

    • s/s infection, dressings/drainage, catheter placement, use of lines (measuring/capped/IVF), changes in readings

Reminder

  • that while advanced monitoring is great technology, you must still look at your patient!