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Advanced Hemodynamics

Everything you need to understand hemodynamic monitoring.

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Introduction to    HEMODYNAMIC MONITORING
DEFINITION PURPOSE DEFINITION HEMODYNAMIC MONITORING ,[object Object],[object Object]
INDICATIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
CONTRAINDICATIONS for an invasive PA Catheter ,[object Object],[object Object],[object Object]
Clinical Scenario Use of PAC ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Hemodynamic Values ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
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Advanced Hemodynamics

Editor's Notes

  1. Changes in CO and SV!
  2. The CO and the SVR will modulate to maintain blood pressure even if CO is very low. Because of this phenomenon, the BP is not a good measure of cardiac output
  3. The pulse pressure tells you more about afterload than the BP does
  4. The Cordis Offers A Large Bore Infusion Port There Are Ten Types Of Swan-Ganz Catheters VIP Catheter Has Three Other Infusion Ports Large Markers = 50cm, Small Markers = 10cm Components: 1. Proximal port – approximately 30 cm from tip of catheter. Also known as the CVP port (central venous pressure). It lies in the right atrium and measures CVP. It can be used for infusion of IV solutions or medications, for drawing blood and for injecting cardiac output boluses. It is usually color coded blue. 2. Distal port – opening is at the tip (end) of the catheter. A lso known as the PA port. It lies directly in the pulmonary artery and measures the pulmonary artery pressures (PAP), systolic (PAS), and diastolic (PAD). It also measures the pulmonary capillary wedge pressure (PCWP) when the balloon is inflated. The PA pressures should always be monitored continuously . NEVER USE the PA port for medication infusion. It c an be used for drawing "mixed venous" blood gas samples. It is u sually color coded yellow. 3. Thermistor and connector port T he thermistor connector connects the pulmonary catheter to the cardiac output computer. The connector is at the end of a separate catheter lumen outside the patient thermistor wire. Blood temperature is transmitted within the lumen (the core temperature is the most accurate reflection of the body temperature). It is used in determining cardiac output. The connector tip should always have a protective covering to protect patient from microshock. It is usually color coded yellow with a red connector. 4. Balloon port The balloon port is located < 1 cm from the tip of the catheter. When the balloon is inflated with approximately 0.8 to 1.5 cc of air, the catheter will become lodged (wedged) in the pulmonary artery and gives a wedge tracing. It r eflects the pressures that are in the left side of the heart when inflated. DO NOT INFLATE WITH LIQUID---- ALWAYS INFLATE WITH AIR. When deflated, turn stopcock to off position and leave syringe connect to the port. It is usually color coded red. 5. A 5 - lumen Swan Ganz catheter has either an infusion port or a pacing port A pacing port allows for insertion of a transvenous pacing wire. The infusion port allows for infusion of IV solutions or medications. It is usually color coded white.
  5. EQUIPMENT NECESSARY FOR INSERTION Flush solution for transducer system Flush solution for cardiac output system Arterial access line Disposable triple pressure transducer system Pulmonary artery catheter                                Monitor, module, electrodes, cables Central line kit                            Transducer holder, I.V. pole, pressure bag Emergency resuscitation equipment     Prepackaged Introducer Kit; sutures Sterile gowns, gloves, and masks
  6. Correct the students about the location of the phlebostatic axis
  7. 1) Normal Pressures: RA = 1-7 RV = 15-25/1-7 PA = 15-25/8-15 PAD = 8-15 PAWP = 6-12
  8. It is essential that you be able to recognize the RV waveform – If the tip migrates to the RV during monitorin it can cause dysrhythmias. The proper intervention is to have an MD or qualified PA/CRNA advance the catheter or you can pull the tip back to the RA. Check your unit’s protocols.
  9. Action taken will depend on unit protocols and availability of an MD or advanced practitioner to reposition the catheter. Know your unit’s protocols before you do anything
  10. Looks like a CVP waveform, but the timing is different
  11. Looks like a CVP waveform – just occurs later
  12. CVP Example
  13. CVP Answer
  14. Example 1
  15. Answer 1
  16. Example 2
  17. Answer 2
  18. Example 3
  19. Answer 3
  20. Example 4
  21. Answer 4
  22. Example 5
  23. Answer 5
  24. Example 6
  25. Answer 6