HEMODYNAMIC

MONITORING
Presented by,
Alma susan
HEMODYNAMICS – DEFINITIONS.

 “Hemodynamic monitoring is the measurement of

pressure, flow, and oxygenation within the
cardiovascular system.”
-LEWIS
 “Hemodynamics is the study of forces involved in the
flow of blood through the cardiovascular and
circulatory systems”
-RAPHAEL GIRAUD
 “Hemodynamic monitoring is the method used to
assess cardiac function, guide and determine the
effectiveness of therapy to minimize cardiac
dysfunction”
-SCTIMT
PURPOSES OF HEMODYNAMIC MONITORING
 • To assess the heart function, fluid
balance, and effects of fluids and drugs on
CO.
 • Early detection, identification and
treatment of life-threatening conditions such
as heart failure and cardiac tamponade
 • Allow immediate evaluation of patient’s
response to treatment such as drugs and
mechanical support
INDICATIONS FOR HEMODYNAMIC MONITORING
  Signs of severe dehydration, hemorrhage,
G.I. bleed
  Burns or surgery
  All types of shock
  Deficit or loss of cardiac function (such as
AMI or CHF)
HEMODYNAMIC TERMINOLOGIES.
 CARDIAC OUTPUT ,CARDIAC INDEX
 PRELOAD
 AFTERLOAD
 VASULAR RESISTANCE
 CONTRACTILITY
HEMODYNAMIC MONITORING –
TYPES
NON INVASIVE INVASIVE HEMODYNAMIC
MONITORING MONITORING
Peripheral and core body Arterial blood pressure monitoring
.
temperature.
Heart rate Central venous pressure

Respiratory rate Pulmonary artery pressure

Blood pressure Left atrial pressure

Oxygen saturation Cardiac output

Noninvasive BP Intracranial pressure.

COMPONENTS OF HEMODYNAMIC MONITORING
  Amplifier – located inside the bedside
monitor; increases the size of signal from the
transducer
  Recorder or monitor – to display the signal
and record information
  Transducer – changes the mechanical
energy or the pressures of pulse into
electrical energy
  Supplemental equipment
  Pressure tubing – prevents tubing distention
BLOOD PRESSSURE
MONITORING.
BLOOD PRESSSURE
MONITORING.
MONITORING OF CARDIAC OUTPUT

 DEFINITION.
1. Amount of blood ejected by each ventricle
per minute. (It’s the cardiac output that
decides the rate of blood flow to the different
parts of the body.)
2. Cardiac ouput is the volume of blood
pumped by the heart per minute and is the
product of the heart rate and stroke volume.
• CO = SV * HR
THERMO DILUTION METHOD
 This method uses a special thermistor – tipped catheter
(Swan-Ganz catheter) inserted from a central vein into
the pulmonary artery. A cold solution of D/W 5% or
normal saline (temperature 0 o C) is injected into the
right atrium from a proximal catheter port. This solution
causes a decrease in blood temperature, which is
measured by a thermistor placed in the pulmonary
artery catheter, The decrease in temperature is
inversely proportional to the dilution of the injectate.
The cardiac output can be derived from the modified
Stewart-Hamilton conservation of heat equation. The
pulmonary artery catheter is attached to the cardiac
output computer, which displays a curve and calculates
output and derived indices automatically
NON-INVASIVE CARDIAC OUTPUT MONITORING

 Oesophageal Doppler
 Transoesophageal echocardiography
 Lithium dilution cardiac output
 Pulse contour cardiac output
 Thoracic electrical bioimpendance
CENTRAL VENOUS PRESSURE
Indications for CVP measurements include:
 • Diagnostic measurements.
 • Monitoring and guiding fluid management.
 • Monitoring and guiding pharmacological
interventions.
MEASUREMENT OF CVP

 The CVP curve comprises several waves: three ascending

deflections (a, c, and v) and two descending waveforms (x and
y). The “a” waveform is due to contraction of the right atrium
subsequent to the electrical stimulation and P wave of the
ECG. The “c” wave is attributed to the isovolumetric
contraction of the right ventricle that induces a bulging
tricuspid valve toward the right atrium. The “x” wave is
attributed to decreased pressure in the right atrium, which
opens the tricuspid valve to the bottom during ejection of the
right ventricle. The “v” wave is formed by the opening of the
tricuspid valve as blood enters the right ventricle. Point “z” is
the atrial pressure before ventricular contraction. There are
approximately 200 ms between the CVP curve and the radial
arterial pressure curve. Therefore, there is an “artificial”
delay between systole transmitted by the radial artery and the
systolic “c” wave of the CVP.
PULMONARY ARTERY
CATHETERS.
NURSING CONSIDERATIONS
  Always level and zero the system to ensure accuracy of values obtained
  Leveling
  Performed to eliminate the effects of hydrostatic pressure on the transducer
  Should be done before and after connecting the pressure system to the
patient, with every change in position of the patient and prior to zeroing and
calibration.
  Always level and zero the system to ensure accuracy of values obtained
  Zeroing
  Performed to eliminate the effects of atmospheric pressure on the
transducer
  Should be performed before and after connecting the pressure system to the
patient, with any leveling and whenever there is a significant change in the
hemodynamic variables
  All values should be rated at the end of expiration
  The catheter must be flushed at least every 8 hours
  Precaution
  Follow electrical safety monitoring guidelines
  Risk to patient: ventricular fibrillation
  A defibrillator, emergency crash cart and medications must be readily
available
COMPLICATIONS

 Pneumothorax
 Constant wedging of the PA catheter
 Ventricular irritation
 Air embolism
 Dampened waveform
 Infection
CONCLUSION
 THANKYOU
 QUESTIONS??