Invasive blood pressure, pulmonary artery catheter, central venous catheter

1. Hemodynamic Monitoring
NIBP,IBP,CVP,PAC
Presenter-Dr. Ranjeet Bihari
MD Anesthesia
Pdcc Neuroanesthesia

2. Introduction
• Critically ill patients require continuos assessment of their
cardiovascular system to diagnose and manage their complex
medical conditions.
• This is most commonly achieved by the use of direct
pressure monitoring systems,often refered to as
hemodynamic monitoring.
• Heart function is the main focus of hemodynamic studies.
• Hemodynamic pressure monitoring provides information
about blood volume , fluid balance and how well the heart
is pumping

3. Monitoring system component
• 1-biological variable
• 2-Sensor
• 3-Integrator( static and dynamic caliberation)
• 4-Out put( displaying the information in waves
and digital form)

4. Invasive
Blood pressure

5. Biological variable
In this arterial blood pressure is
measured invasively

8. Zeroing and leveling
• Zeroing is done by exposing the transducer to
atmospheric pressure and calibrating the
pressure reading to zero
Is any relation between zeroing and
leveling???

9. PHLEBOSTATIC AXIS

10. Work of strain gauge

12. Modern wheat stone bridge

13. Integrator
• This is done by the computer. For this there is
need of the caliberation
• Two types of caliberation

17. 1-Resonance

21. Question
• Which parmeter does not effected by the
dmping?

22. Answer
• . A monitoring system with too low a
frequency response (over-dampened and a
depressed waveform) or a high frequency
response (under-dampened and a rather
vibrant waveform) will result in
underestimation or overestimation,
respectively, of the arterial pulse pressure
without altering the accuracy of reporting the
mean arterial pressure (MAP)

23. Physilogical basis of arterial waveform

24. Arteria pressure

25. Distal arterial tree amplification
• MAP remains constant
• 60 ms delay in the aortic up stroke and its
peripheral counterpart

27. Out come::
normal graph

28. Derived parameters of the arterial
wave forms
• It is created by this pulse pressure profile.
These include estimates of left ventricular
stroke volume (SV), CO, vascular resistance,
and during positive-pressure breathing, SV
variation, and pulse pressure variation

29. • By this pulse pressure profile. These include
estimates of left ventricular stroke volume
(SV), CO, vascular resistance, and during
positive-pressure breathing, SV variation, and
pulse pressure variation (PPV)

30. contractility
This is dp/dt ;quicker rise ---more dp/dt—more
contractility

31. Central arterial compliance
• Older the person lesser the arterial
compliance; greater pulse pressure
• Younger the person more the arterial
compliance; lessar pulse pressure

32. Peripheral vascular resistance
• When SV is stable and/or fixed, changes in
vascular resistance will manifest as changes in the
downslope of the arterial waveform. If the
arterial waveform downstroke sharply decreases,
as often is the case with vasodilator therapy or
sepsis, there is little resistance to blood flow.
• If the downstroke of the arterial waveform is
rather shallow, as is often in the case of severe
heart failure, then this indicates a higher
resistance

33. Hypovolumia
• . Hypovolemia will cause a large increase in
the variation of both systolic pressure and
pulse pressure compared to normovolemic
states.
• Large systolic pressure or PPVs are correlated
with lower amounts of intrathoracic blood
volume and ventricular filling pressures

35. Questation
&
Answer

36. • What are the main components of
an intra-arterial blood pressure
measuring system?

38. • . Why should an intra-arterial blood pressure
measurement system have a high natural
frequency?

39. • Why should a pressure transducer be
positioned at the same level as the
patient’s heart? .

40. • What features of an intra-arterial blood
pressure measurement system help to
reduce errors from excessive damping

41. • Tubing should be –
• Stiff &low compliance
• Stiff and high compliance
• Only stiff