Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.
CENTRAL LINESCENTRAL LINES
ANDAND
ARTERIAL LINESARTERIAL LINES
SHARON HARVEYSHARON HARVEY
26/01/0426/01/04
LEARNING OUTCOMESLEARNING OUTCOMES
THE STUDENT SHOULD BE ABLETHE STUDENT SHOULD BE ABLE
TO:-TO:- IDENTIFY A CENTRAL LINE ...
WHAT IS A CENTRAL LINEWHAT IS A CENTRAL LINE
 It is a catheter thatIt is a catheter that
provides venousprovides venous
a...
COMMON CENTRAL LINECOMMON CENTRAL LINE
INSERTION SITESINSERTION SITES
 Right internal jugularRight internal jugular
 lef...
TYPES OF CENTRAL LINETYPES OF CENTRAL LINE
 SINGLE LUMENSINGLE LUMEN
 TRIPLE LUMENTRIPLE LUMEN
 QUADRUPLEQUADRUPLE
LUME...
CENTRAL LINESCENTRAL LINES
 Indications for CVP lines are:-Indications for CVP lines are:-
 fluid resuscitationfluid res...
COMPLICATIONSCOMPLICATIONS
FOLLOWING CVP LINEFOLLOWING CVP LINE
INSERTIONINSERTION
 Malposition of theMalposition of the
...
CENTRAL VENOUSCENTRAL VENOUS
PRESSUREPRESSURE
WHAT IS CENTRAL VENOUSWHAT IS CENTRAL VENOUS
PRESSUREPRESSURE
 IS THE PRESSURE WITHIN THEIS THE PRESSURE WITHIN THE
SUPER...
CVP READINGS ARE USED:-CVP READINGS ARE USED:-
 TO SERVE AS A GUIDE TO FLUIDTO SERVE AS A GUIDE TO FLUID
BALANCE IN CRITI...
CENTRAL VENOUSCENTRAL VENOUS
PRESSURE MONITORINGPRESSURE MONITORING
 THIS IS A HELPFUL TOOL IN THETHIS IS A HELPFUL TOOL ...
METHODS OF CVPMETHODS OF CVP
MONITORINGMONITORING
 There are two methods of CVP monitoringThere are two methods of CVP mo...
MONITORING WITHMONITORING WITH
TRANSDUCERSTRANSDUCERS
 Transducers enable the pressure readingsTransducers enable the pre...
PROCEDURE FOR CVP MEASUREMENTPROCEDURE FOR CVP MEASUREMENT
USING A TRANSDUCERUSING A TRANSDUCER
 EXPLAIN THE PROCEDURE TO...
THE CVP WAVEFORMTHE CVP WAVEFORM
 The CVP waveform reflects changes inThe CVP waveform reflects changes in
right atrial p...
NORMAL CVPNORMAL CVP
MEASUREMENTSMEASUREMENTS Central venous presure monitoring shouldCentral venous presure monitoring s...
CENTRAL
VENOUS
PRESSURE
CVP
BLOOD VOLUME
(INCREASED
VENOUS RETURN
RAISES CVP
CARDIAC
COMPETENCE
(REDUCED
VENTRICULAR
FUNCT...
MANAGEMENT OF A PATIENTMANAGEMENT OF A PATIENT
WITH A CVP LINEWITH A CVP LINE
 Monitor the patient for signs ofMonitor th...
 Ensure all connections are secure toEnsure all connections are secure to
prevent exsanguination, introduction ofprevent ...
REMOVAL OF CENTRAL LINEREMOVAL OF CENTRAL LINE
 THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE
 THE PATIENT SH...
ARTERIAL LINESARTERIAL LINES
WHAT IS AN ARTERIAL LINE?WHAT IS AN ARTERIAL LINE?
 AN ARTERIAL LINEAN ARTERIAL LINE
IS A CANNULAIS A CANNULA
USUALLYUSUA...
INDICATIONS FOR USINGINDICATIONS FOR USING
ARTERIAL LINEARTERIAL LINE
 Ease of accessEase of access
 ContinuousContinuou...
COMPLICATIONS ASSOCIATEDCOMPLICATIONS ASSOCIATED
WITH ARTERIAL LINESWITH ARTERIAL LINES
 HYPOVOLAEMIAHYPOVOLAEMIA
 ACCID...
THE ARTERIAL WAVEFORMTHE ARTERIAL WAVEFORM
 The arterial waveformThe arterial waveform
reflects the pressurereflects the ...
REMOVAL OF ARTERIAL LINEREMOVAL OF ARTERIAL LINE
 THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE
 REMEMBER UNI...
QUESTIONS????QUESTIONS????
Haemodynamic monitoring
Haemodynamic monitoring
Haemodynamic monitoring
Upcoming SlideShare
Loading in …5
×

Haemodynamic monitoring

2,118 views

Published on

CVC LINE ART LINES IN ICU

Published in: Health & Medicine
  • Be the first to comment

Haemodynamic monitoring

  1. 1. CENTRAL LINESCENTRAL LINES ANDAND ARTERIAL LINESARTERIAL LINES SHARON HARVEYSHARON HARVEY 26/01/0426/01/04
  2. 2. LEARNING OUTCOMESLEARNING OUTCOMES THE STUDENT SHOULD BE ABLETHE STUDENT SHOULD BE ABLE TO:-TO:- IDENTIFY A CENTRAL LINE ANDIDENTIFY A CENTRAL LINE AND ARTERIAL LINEARTERIAL LINE  DISCUSS THE INDICATIONS FORDISCUSS THE INDICATIONS FOR CENTRAL LINES AND ARTERIAL LINESCENTRAL LINES AND ARTERIAL LINES  DISCUSS THE COMPLICATIONSDISCUSS THE COMPLICATIONS ASSOCIATED WITH CENTRAL LINESASSOCIATED WITH CENTRAL LINES AND ARTERIAL LINESAND ARTERIAL LINES  ARTICULATE THE MANAGEMENT OF AARTICULATE THE MANAGEMENT OF A PATIENT WITH A CENTRAL LINEPATIENT WITH A CENTRAL LINE AND/OR ARTERIAL LINEAND/OR ARTERIAL LINE
  3. 3. WHAT IS A CENTRAL LINEWHAT IS A CENTRAL LINE  It is a catheter thatIt is a catheter that provides venousprovides venous access via theaccess via the superior vena cava orsuperior vena cava or right atriumright atrium
  4. 4. COMMON CENTRAL LINECOMMON CENTRAL LINE INSERTION SITESINSERTION SITES  Right internal jugularRight internal jugular  left internal jugularleft internal jugular  right subclavianright subclavian  left subclavianleft subclavian  femoral (as a lastfemoral (as a last resort)resort)  Or peripherallyOr peripherally inserted centralinserted central catheters (PICC)catheters (PICC) which are inserted viawhich are inserted via the antecubital veinsthe antecubital veins (basilic vein is the(basilic vein is the best) in the arm andbest) in the arm and is advanced into theis advanced into the central veinscentral veins
  5. 5. TYPES OF CENTRAL LINETYPES OF CENTRAL LINE  SINGLE LUMENSINGLE LUMEN  TRIPLE LUMENTRIPLE LUMEN  QUADRUPLEQUADRUPLE LUMENLUMEN  QUINTUPLE LUMENQUINTUPLE LUMEN
  6. 6. CENTRAL LINESCENTRAL LINES  Indications for CVP lines are:-Indications for CVP lines are:-  fluid resuscitationfluid resuscitation  Parenteral feedingParenteral feeding  measurement of central venous pressuremeasurement of central venous pressure  poor venous accesspoor venous access  administration of irritant drugsadministration of irritant drugs
  7. 7. COMPLICATIONSCOMPLICATIONS FOLLOWING CVP LINEFOLLOWING CVP LINE INSERTIONINSERTION  Malposition of theMalposition of the cathetercatheter  haematomahaematoma  arterial puncturearterial puncture  pneumothoraxpneumothorax  haemorrhagehaemorrhage  sepsissepsis  air emboliair emboli  Catheter embolismCatheter embolism  ThrombosisThrombosis  HaemothoraxHaemothorax  Cardiac tamponadeCardiac tamponade  Cardiac arrhythmiasCardiac arrhythmias
  8. 8. CENTRAL VENOUSCENTRAL VENOUS PRESSUREPRESSURE
  9. 9. WHAT IS CENTRAL VENOUSWHAT IS CENTRAL VENOUS PRESSUREPRESSURE  IS THE PRESSURE WITHIN THEIS THE PRESSURE WITHIN THE SUPERIOR VENA CAVA OR THE RIGHTSUPERIOR VENA CAVA OR THE RIGHT ATRIUMATRIUM
  10. 10. CVP READINGS ARE USED:-CVP READINGS ARE USED:-  TO SERVE AS A GUIDE TO FLUIDTO SERVE AS A GUIDE TO FLUID BALANCE IN CRITICALLY ILL PATIENTSBALANCE IN CRITICALLY ILL PATIENTS  TO ESTIMATE THE CIRCULATINGTO ESTIMATE THE CIRCULATING BLOOD VOLUMEBLOOD VOLUME  TO ASSIST IN MONITORINGTO ASSIST IN MONITORING CIRCULATORY FAILURECIRCULATORY FAILURE
  11. 11. CENTRAL VENOUSCENTRAL VENOUS PRESSURE MONITORINGPRESSURE MONITORING  THIS IS A HELPFUL TOOL IN THETHIS IS A HELPFUL TOOL IN THE ASSESSMENT OF CARDIAC FUNCTION,ASSESSMENT OF CARDIAC FUNCTION, CIRCULATING BLOOD VOLUME, VASCULARCIRCULATING BLOOD VOLUME, VASCULAR TONE AND THE PATIENT’S RESPONSE TOTONE AND THE PATIENT’S RESPONSE TO TREATMENTTREATMENT  HOWEVER, CVP SHOULD NOT BEHOWEVER, CVP SHOULD NOT BE INTERPRETED SOLELY BUT ININTERPRETED SOLELY BUT IN CONJUNCTION WITH OTHER SYSTEMICCONJUNCTION WITH OTHER SYSTEMIC MEASUREMENTS, AS ISOLATED CVPMEASUREMENTS, AS ISOLATED CVP MEASUREMENTS CAN BE MISLEADINGMEASUREMENTS CAN BE MISLEADING
  12. 12. METHODS OF CVPMETHODS OF CVP MONITORINGMONITORING  There are two methods of CVP monitoringThere are two methods of CVP monitoring  manometer system:manometer system: enables intermittentenables intermittent readings and is less accurate than thereadings and is less accurate than the transducer systemtransducer system  transducer system:transducer system:enables continuousenables continuous readings which are displayed on a monitor.readings which are displayed on a monitor.
  13. 13. MONITORING WITHMONITORING WITH TRANSDUCERSTRANSDUCERS  Transducers enable the pressure readingsTransducers enable the pressure readings from invasive monitoring to be displayedfrom invasive monitoring to be displayed on a monitoron a monitor  To maintain patency of the cannula a bagTo maintain patency of the cannula a bag of normal saline or heparinised salineof normal saline or heparinised saline should be connected to the transducershould be connected to the transducer tubing and kept under continuoustubing and kept under continuous pressure of 300mmHg thus facilitating apressure of 300mmHg thus facilitating a continuous flush of 3mls/hrcontinuous flush of 3mls/hr
  14. 14. PROCEDURE FOR CVP MEASUREMENTPROCEDURE FOR CVP MEASUREMENT USING A TRANSDUCERUSING A TRANSDUCER  EXPLAIN THE PROCEDURE TO THE PATIENTEXPLAIN THE PROCEDURE TO THE PATIENT  ENSURE THE LINE IS PATENTENSURE THE LINE IS PATENT  POSITION THE PATIENT SUPINE (IF POSSIBLE) ANDPOSITION THE PATIENT SUPINE (IF POSSIBLE) AND ALIGN THE TRANSDUCER WITH THE MID AXILLAALIGN THE TRANSDUCER WITH THE MID AXILLA (LEVEL WITH THE RIGHT ATRIUM)(LEVEL WITH THE RIGHT ATRIUM)  ZERO THE MONITORZERO THE MONITOR  OBSERVE THE CVP TRACEOBSERVE THE CVP TRACE  DOCUMENT THE READING AND REPORT ANYDOCUMENT THE READING AND REPORT ANY CHANGES OR ABNORMALITIESCHANGES OR ABNORMALITIES
  15. 15. THE CVP WAVEFORMTHE CVP WAVEFORM  The CVP waveform reflects changes inThe CVP waveform reflects changes in right atrial pressure during the cardiacright atrial pressure during the cardiac cyclecycle
  16. 16. NORMAL CVPNORMAL CVP MEASUREMENTSMEASUREMENTS Central venous presure monitoring shouldCentral venous presure monitoring should normally show measurements as follows:normally show measurements as follows:  Mid Axilla: 0 - 8 mmHg (Woodrow 2000)Mid Axilla: 0 - 8 mmHg (Woodrow 2000)  An isolated CVP reading is of limitedAn isolated CVP reading is of limited value; a trend of readings is much morevalue; a trend of readings is much more significant and should be viewed insignificant and should be viewed in conjuncton with other parameters e.g. BPconjuncton with other parameters e.g. BP and urine output.and urine output.
  17. 17. CENTRAL VENOUS PRESSURE CVP BLOOD VOLUME (INCREASED VENOUS RETURN RAISES CVP CARDIAC COMPETENCE (REDUCED VENTRICULAR FUNCTION RAISES CVP) INTRATHORACI C AND INTRAPERITON EAL PRESSURE (RAISES CVP) SYSTEMIC VASCULAR RESISTENCE (INCREASED TONE RAISES CVP)
  18. 18. MANAGEMENT OF A PATIENTMANAGEMENT OF A PATIENT WITH A CVP LINEWITH A CVP LINE  Monitor the patient for signs ofMonitor the patient for signs of complicationscomplications  Label CVP lines with drugs/fluids etc.Label CVP lines with drugs/fluids etc. being infused in order to minimise the riskbeing infused in order to minimise the risk of accidental bolus injectionof accidental bolus injection  If not in use, flush the cannula regularly toIf not in use, flush the cannula regularly to help prevent thrombosis. A 500ml bag ofhelp prevent thrombosis. A 500ml bag of 0.9% normal saline should be maintained0.9% normal saline should be maintained at a pressure of 300mmHg.at a pressure of 300mmHg.
  19. 19.  Ensure all connections are secure toEnsure all connections are secure to prevent exsanguination, introduction ofprevent exsanguination, introduction of infection and air emboliinfection and air emboli  Observe the insertion site frequently forObserve the insertion site frequently for signs of infection.signs of infection.  The length of the indwelling catheterThe length of the indwelling catheter should be recorded and regularlyshould be recorded and regularly monitored.monitored.  CVP lines should be removed whenCVP lines should be removed when clinically indicatedclinically indicated
  20. 20. REMOVAL OF CENTRAL LINEREMOVAL OF CENTRAL LINE  THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE  THE PATIENT SHOULD BE SUPINE WITH HEADTHE PATIENT SHOULD BE SUPINE WITH HEAD TILTED DOWNTILTED DOWN  ENSURE NO DRUGS ARE ATTACHED AND RUNNINGENSURE NO DRUGS ARE ATTACHED AND RUNNING VIA THE CENTRAL LINEVIA THE CENTRAL LINE  REMOVE DRESSINGREMOVE DRESSING  CUT THE STITCHESCUT THE STITCHES  SLOWLY REMOVE THE CATHETERSLOWLY REMOVE THE CATHETER  IF THERE IS RESISTENCE THEN CALL FORIF THERE IS RESISTENCE THEN CALL FOR ASSISTANCEASSISTANCE  APPLY DIGITAL PRESSURE WITH GAUZE UNTILAPPLY DIGITAL PRESSURE WITH GAUZE UNTIL BLEEDING STOPSBLEEDING STOPS  DRESS WITH GAUZE AND CLEAR DRESSING EGDRESS WITH GAUZE AND CLEAR DRESSING EG TEGADERMTEGADERM
  21. 21. ARTERIAL LINESARTERIAL LINES
  22. 22. WHAT IS AN ARTERIAL LINE?WHAT IS AN ARTERIAL LINE?  AN ARTERIAL LINEAN ARTERIAL LINE IS A CANNULAIS A CANNULA USUALLYUSUALLY POSITIONED IN APOSITIONED IN A PERIPHERALPERIPHERAL ARTERYARTERY  SUCH ASSUCH AS  Radial arteryRadial artery  brachial arterybrachial artery  dorsalis pedis arterydorsalis pedis artery  femoral arteryfemoral artery
  23. 23. INDICATIONS FOR USINGINDICATIONS FOR USING ARTERIAL LINEARTERIAL LINE  Ease of accessEase of access  ContinuousContinuous monitoring of arterialmonitoring of arterial blood pressureblood pressure  if patient is onif patient is on intropic drugsintropic drugs  if patient is onif patient is on vasoactive drugvasoactive drug  if patient requiresif patient requires frequent arterialfrequent arterial blood samplingblood sampling
  24. 24. COMPLICATIONS ASSOCIATEDCOMPLICATIONS ASSOCIATED WITH ARTERIAL LINESWITH ARTERIAL LINES  HYPOVOLAEMIAHYPOVOLAEMIA  ACCIDENTAL INTR-ARTERIALACCIDENTAL INTR-ARTERIAL INJECTION OF DRUGSINJECTION OF DRUGS  LOCAL DAMAGE TO ARTERYLOCAL DAMAGE TO ARTERY
  25. 25. THE ARTERIAL WAVEFORMTHE ARTERIAL WAVEFORM  The arterial waveformThe arterial waveform reflects the pressurereflects the pressure generated in thegenerated in the arteries followingarteries following ventricular contractionventricular contraction and can be describedand can be described as having:-as having:-  Anacrotic notchAnacrotic notch  Peak systolicPeak systolic pressurepressure  Dicrotic notchDicrotic notch  Diastolic pressureDiastolic pressure
  26. 26. REMOVAL OF ARTERIAL LINEREMOVAL OF ARTERIAL LINE  THIS IS AN ASEPTIC PROCEDURETHIS IS AN ASEPTIC PROCEDURE  REMEMBER UNIVERSAL PRECAUTIONSREMEMBER UNIVERSAL PRECAUTIONS  THE PROCEDURE SHOULD BE EXPLAINED TO THETHE PROCEDURE SHOULD BE EXPLAINED TO THE PATIENTPATIENT  TAKE DRESSING OFF LINETAKE DRESSING OFF LINE  REMOVE ARTERIAL LINE ENSURING THAT THEREMOVE ARTERIAL LINE ENSURING THAT THE ENTRY SITE IS COVERED WITH GAUZEENTRY SITE IS COVERED WITH GAUZE  APPLY DIGITAL PRESSURE FOR AT LEAST 5APPLY DIGITAL PRESSURE FOR AT LEAST 5 MINUTES TO ENSURE HAEMOSTASISMINUTES TO ENSURE HAEMOSTASIS  DRESS SITE WITH GAUZE AND MICROPOREDRESS SITE WITH GAUZE AND MICROPORE  ASSESS THE PERIPHERAL CIRCULATION ASASSESS THE PERIPHERAL CIRCULATION AS THROMBOSIS CAN OCCUR AFTER REMOVALTHROMBOSIS CAN OCCUR AFTER REMOVAL
  27. 27. QUESTIONS????QUESTIONS????

×