clinical Monitoring

1. Clinical Monitoring
By – Subhasis Goswami
B.Sc MLT
HLG Hospital

2. Definition
Clinical monitoring is the
oversight and administrative efforts
that monitor a participant's health
and efficacy of the treatment during a
clinical trial.

3. Overview
Blood pressure monitoring –
(i) NIBP (ii) IBP
Central venous pressure monitoring
Pulmonary artery pressure monitoring
Allen’s Test
CVP Catherization
Devices used for Monitoring

4. Necessity of Monitor BP
Alterations inherent .
Provides data for interpretation/therapeutic
decisions .
Important for determining organ perfusion (MAP
most important, except with the heart) .
Blood pressure monitoring is an important element
in evaluating general health and most diseases and
conditions.

5. Noninvasive Hemodynamic Monitoring
Noninvasive BP
Heart Rate
 Pulses
Mental Status
Mottling (absent)
Skin Temperature
Capillary Refill
Urine Output

6. Indications for Arterial Blood Pressure
Frequent titration of vasoactive drips .
Major surgery involving large fluid shifts
or EBL.
Aortic surgery .
Unstable blood pressures .
Frequent ABGs or labs .
Unable to obtain Non-invasive BP .

7. NON INVASIVE BLOOD PRESSURE MONITORING
History
Non-invasive techniques for the measurement of blood pressure
have been in existence since the early 1800s, although Riva Rocci, an
Italian physician, is credited with developing the first conventional
sphygmomanometer in 1896.
Defination
Blood pressure is the lateral pressure exerted by the column of
blood against the arterial walls. During the cardiac cycle the highest
pressure attained is the systolic pressure and the lowest pressure is the
diastolic pressure.

8. NIBP METHODS
PALPATORY METHOD
AUSCULATORY METHOD
DOPPLER
OSCILLOMETRY
PLETHYSMOGRAPHY
TONOMETRY

9. INVASIVE BLOOD PRESSURE (IBP)
 Indications
 Major surgical procedures involving large fluid shifts or blood loss .
 Surgery requiring cardiopulmonary bypass .
 Surgery of the aorta .
 Patients with pulmonary disease requiring frequent arterial blood gases .
 Patients with recent myocardial infarctions, unstable angina, or severe coronary artery disease .
 Patients with decreased left ventricular function (congestive heart failure) or significant valvular
heart disease .
 Patients in hypovolemic, cardiogenic, or septic shock or with multiple organ failure .
 Inability to measure BP noninvasively (e.g., morbid obesity) .

10. IBP CURVE

11. Arterial BP Monitoring
In short :INDICATIONS:
-Anticipated Hypotension .
-Wide Blood Pressure Deviations .
-End Organ Damage -Need for multiple ABG
measurements .

12. Sites Factors that influence the site of arterial
cannulation
Location of surgery .
The possible compromise of arterial flow due to patient
positioning or surgical manipulations, .
Any history of ischemia of or prior surgery on the limb to be
cannulated.
The presence of a proximal arterial cutdown. The proximal
cutdown may cause damped waveforms or falsely low BP
readings due to stenosis or vascular thrombosis.

13. ADVANTAGES & DISADVANTAGES RADIAL ARTERY
 Superficial location.
 Easy to identify and cannulate.
 Collateral circulation.
 CC can be assessed.
 Accessible during major surgeries.
 Patient can be mobilized.
 Small size artery.
 Higher rate of catheter malfunction.
 Not reliable in vasoconstriction.
 Considerable augmentation of SBP.
 Overshoot artifact.

14. Allen’s test
 5% Patients have incomplete palmar arches. So predispose them to
inadequate blood flow if either artery flow disrupted.
 ormal collateral circulation- color returns to the hand in about 5 seconds.
 >15 seconds to return to its normal color, cannulation is controversial.
 Variations on allen's test include using a doppler probe or pulse oximeter
to document collateral flow

15. Other Sites
 The brachial artery lies in close proximity to the median nerve. Its pressure tracings resemble
those in the femoral artery, and were found to more accurately reflect central aortic pressures
(Kinking problem).
 The femoral artery may be cannulated for monitoring purposes but is usually reserved for
situations in which other sites are unable to be cannulated or it is specifically indicated
(e.g., descending thoracic aortic aneurysm surgery for distal pressure monitoring).
 The femoral artery for hemodynamic monitoring purposes was as safe as radial artery
cannulation (Atheroma, Pseuaneurysm, Infections, Thrombosis, Rarely- Aseptic necrosis of
head of femur in children).
 Axillary artery .

16. Insertion Techniques
Direct cannulation .
Transfixation Seldinger technique.
Doppler assisted technique .
Two dimensional USG assisted method .
Surgical cutdown .

17. CENTRAL VENOUS PRESSURE (CVP)
Defination
Central venous pressure (CVP) is the
pressure in the thoracic vena cava near the right atrium.
Range
2 - 8 mmHg , 3 -10 CmH2o

18. CVP SITE
 Central Vein .
Right Internal Jugular Vein .
Left Internal Jugular Vein .
Femoral Vein ( Right & Leg ).
Subclavian Vein .( Right & Leg ).

19. CVP Cathirization

20. IDICATION
To measure the CVP
To introduce Cardiac Panniing
To Administer Inotropes
To Provide Electrolytes Correction . (ABG )
( Arterial Blood Gases )

21. Devices Used for Monitoring
The Human NIBP Nano Monitoring System
It allows recording and measurement of a continuous blood
pressure signal from an adult human via a non-invasive dual
finger cuff system.

22. Sphygmomanometer
 An instrument for measuring blood pressure and
especially arterial blood pressure.

23. Pulse Oximeter
Glucometer - .
Thermometer -

24. ECG Mechine
STETHOSCOPE