HEMODYNAMIC MONITORING NON INVASIVE

1. Hemodynamic
monitoring non
invasive
Monika Negi
M.Sc. Nursing
(Critical care)
AIIMS 1

2. OBJECTIVES
At the end of the class student will able to
Define hemodynamic monitoring.
Explain the purpose of hemodynamic monitoring.
Enumerate the indication of hemodynamic monitoring.
Describe the types of hemodynamic monitoring.
Explain the method of non-invasive monitoring
including temperature, pulse , respiration, blood
pressure, capillary refill time and ECG 2

3. Introduction
 Hemodynamics, literally means "blood movement” through the
heart.
 Hemodynamic monitoring is the measurement of pressure, flow
and oxygenation of blood within the CVS that provides:
 Quantitative information about vascular capacity, blood
volume pump effectiveness and tissue perfusion
 Information reflecting the earliest changes in the circulatory
system that are not yet clinically detectable. 3

4. Purpose
• Early detection, identification, and treatment of life-
threatening conditions such as heart failure and
cardiac tamponade.
• Evaluate the patient’s immediate response to
treatment such as drugs and mechanical support.
• Evaluate the effectiveness of cardiovascular function
such as cardiac output and index.
4

5. Indications
All types of shock
e.g. cardiogenic , hypovolemic, distributive and obstructive
Decreased cardiac output
e.g. dehydration , haemorrhage, G.I. bleed, burns, or post
surgery
Any deficient or loss of cardiac function
e.g. acute MI, CHF, cardiomyopathy
5

6. Types of monitoring
• Continous v/s intermittent
• Invasive v/s non invasive
6

7. Types of hemodynamic
monitoring
Temperature
Respiratory rate
Heart rate and Pulse rate
Non invasive blood pressure
(NIBP)
SpO2
Capillary refill time
ECG
7
 Non invasive

8. Continue…
Invasive
Central venous pressure(CVP)
Pulmonary artery pressure(PAP)
Intra arterial blood pressure cardiac output(CO)
Arteriovenous gas analysis(ABG)
8

9. Temperature monitoring
9

10. Indication of temperature
monitoring
• Fever
• Hyperthermia
• Heatstroke
• Hypothermia
• Frostbite
• Heat exhaustion
• Assessment of hemodynamic status 10

11. Route of temperature
monitoring
• Oral
• Axilla
• Rectum
• Tympanic membrane
• Skin
• Temporal artery
11

12. Acceptable range for adult
Temperature range 36-38 deg. C (96.8- 100.4 deg.F)
Average oral/tympanic 36-38deg. C (96.8-98.6 deg. F)
Average axillary 36.5deg. C (97.7deg. F)
Average rectal 37deg. C (98.6 deg. F)
Average tympanic 37.5 deg. C (99.5deg. F)
12

13. Temperature monitoring devices
1. Electronic thermometer
a) For oral and rectal monitoring
• predictive temperature: 4 sec
• Standard temperature :3 min
13

14. 14
b)Tympanic membrane thermometer
Timing: within seconds
c)Temporal artery thermometer
timing: within seconds

15. 15
d) Digital thermometer
timing: 3 min
e)Infrared thermometer
timing: within seconds

16. Chemical dot thermometer
16
Types
1.Single use
2.Reusable
Version
1.Celsius version
50 dots each represent temp. increment of 0.1 deg.
Celsius over a range of 35.5 -40.4 deg. Celsius
2.Fahrenheit version
45 dots each represent temp. increment of 0.2 deg. F
over a range of 96 -104.8 deg. F
COLOUR
change within
60 sec.

17. Pulse rate
17

18. Factors influencing pulse rate
Sr.
no.
Factors Increase pulse rate Decrease pulse rate
1. Exercise Short term excercise Long term exercise
2. Temperature Hyperthermia hypothermia
3. Emotion Acute pain , anxiety Unrelieved pain , relaxation
4. Drug Positive chronotropic Negative chronotropic
5. Hemorrhage Loss of blood
6. Postural changes Standing or sitting Lying down
7. Pulmonary condition Asthma ,COPD
18

19. Pulse point on the body
19
Temporal
Apical

20. Method of assessing pulse
• Palpation
• Auscultation
• ECG
• Spo2 probe
20

21. Characters of pulse
• Rate
• Rhythm
• Strength
• Equality
• Force
• Tension
• Form
21

22. Patterns of pulse
• Dicrotic pulse
• Pulsus alternans
• Pulsus bigeminus
• Pulsus bisferiens
• Pulsus tardus et parvus
• Pulsus paradoxus
22

23. 23

24. Factors influencing character of
respiration
• Exercise
• Acute pain
• Anxiety
• Smoking
• Body position
• Medication
• Neurological injury
• Haemoglobin function
24

25. Method of assessing respiration
25

26. Characteristics of respiration
• Rate
• Depth
• rhythm
26

27. Alternation in breathing pattern
• Bradypnoea
• Tachypnoea
• Apnoea
• Hyperventilation
• Hypoventilation
• Cheyne stokes respiration
• Kussmaul’s respiration
• Biot’s respiration
• Paradoxical respiration
27

28. Pulse oximetry
28

29. Purpose
• It is used to detect sudden changes in saturation of
oxygen
Unreliable the value when
• Cardiac arrest
• Shock
• Sepsis
29

30. Sites of placing probe
30

31. Mechanism
31
It works on the principle of spectrometry

32. Factors affecting determination
of Spo2
Interference with light transmission
• Outside light sources
• Carbon monooxide
• Patient motion
• Jaundice
• Intravacular dyes
• Nail polish, artificial nail
• Dark skin pigment 32

33. Interference with arterial
pulsation
• Peripheral vascular disease
• Hypotension
• Hypothermia
• Vasoconstrictors
• Peripheral edema
33

34. Blood pressure monitoring
34

35. 35

36. Factors influencing blood
pressures
36
•Age
•Stress
•Ethnicity
•Gender
•Daily variation
•Medication
•Activity
•Weight
•Smoking

37. Types of BP monitors
37

38. 38

39. Position for measuring blood pressure
39

40. Sites for measuring BP
40

41. 41

42. 42
90-99
> Or =100
80-89

43. Capillary refill test
43

44. Electrocardiogram
44

45. Types of ECG machines
45

46. 46

47. 47
3 LEAD ECG
5 LEAD ECG

48. ECG Graph
48

49. Normal sinus rhythm
49
V and A rate : 60 to 100
V and A rhythm :regular
QRS shape and duration : normal
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1

50. Sinus bradycardia
50
V and A rate :LESS THAN 60
V and A rhythm :regular
QRS shape and duration : normal
P WAVE : ALWAYS IN FRONT of QRS
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1

51. Sinus tachycardia
51
V and A rate :greater THAN 100 but less than 120
V and A rhythm :regular
QRS shape and duration : normal
P WAVE : ALWAYS IN FRONT of QRS
PR interval : Consistent interval between 0.12 and 0.20
P:QRS : 1:1

52. Atrial fibrillation and atrial
flutter
52
V and A rate : A rate b/w 300- 600 V rate b/w 120-200
V and A rhythm :highly irregular
QRS shape and duration : normal may be abnormal
P WAVE : non discernable called F wave
PR interval :difficult to determine
P:QRSmany :1

53. Ventricular tachycardia
53
V and A rate : V rate b/w 100-200 and atrial rate depend upon underlying rhythm
V and A rhythm :usually regular
QRS shape and duration :abnormal shape 0.12sec
P WAVE : difficult to detect
PR interval :difficult to determine
P:QRSmany :more QRS then P

54. Ventricular fibrillation
54
V and A rate : V > 300
V and A rhythm :extremely irregular
QRS shape and duration :irregular ,undulating waves without recognizable QRS complex

55. ST Segment changes
55

56. 56

57. Nursing management
57

58. Nursing responsibility in invasive
hemodynamic monitoring
• Explain procedure to the patient.
• Inspection of the site of application for any kind of skin
irritation.
• Immediate reporting and appropriate action in case of
any deviation from normal.
• Documentation for vital sign
• Recording of event
58

59. Conclusion
Non invasive hemodynamic monitoring is a save
detection method of hemodynamic changes. It is
very important to measure these changes in order to
prevent any complications. Nurses play a key role in
detecting these changes.
59

60. Summary
60
Hemodynamic monitoring
Purpose indication
Types
Non-invasive method
•Temperature
•Pulse
•respiration
•Blood pressure
•Capillary refill
•ECG

61. temp
61

62. 62