Intensive care monitoring system

1. INTENSIVE
CARE
MONITORING
SYSTEM

2. PRESENTED BY
Mohamed kheder
Pediatric nursing department

3. At the end of this lecture the students will be able to:
 Define what is the monitoring mean.
 Enumerate types of monitoring.
 Determine method of respiratory monitoring.
 Discus cardiovascular monitoring.
Objectives

4. Outlines
 The monitoring mean.
 Types of monitoring.
 Method of respiratory monitoring.
 Cardiovascular monitoring.

5. What is child Monitoring?
 “Repeated or continuous observations or measurements of the child ,
his or her physiological function, and the function of life support
equipment, for the purpose of guiding management decisions,
including when to make therapeutic interventions, and assessment of
those interventions” [Hudson, 1985, p. 630].

6. CONT.
 A child monitor may not only alert caregivers to potentially life-
threatening events; many provide physiologic input data used to control
directly connected life-support devices.

7. History of Physiological data
measurements
 1625 Santorio-measure body temperature with spirit thermometer.
Timing pulse with pendulum.
 Principles were established by Galileo. These results were ignored.
 1707 Sir John Foyer published pulse watch.
 At this time Temperature, pulse rate respiratory rate had become
standard vital signs.
 1896 Scipione Riva-Rocci introduced the sphygmomanometer (blood
pressure cuff). (4th vital sign).

8. CONT.
 Nikolai koroktoff applied the cuff with the stethoscope (developed by
Renne Lannec-French Physician) to measure systolic and diastolic blood
pressures
 1903 Willem Einthoven devised the string galvanometer to measure ECG
(Nobel Prize 1924)
 90 Computer-based patient monitors - Systems with database functions,
report-generation systems, and some decision-making capabilities.

9. Monitoring system
 Monitoring equipment depend on basic equipments, physical
principles, physiology &underlying conditions.
 Increase amount of monitoring doesn’t reduce the need for close
observation & clinical examination of the child by the SICU nurse
& medical staff.

10. General Guidelines
 Monitoring ensures rapid detection of changes in the clinical status
 Allows for accurate assessment of progress and response to therapy
 When clinical signs and monitored parameters disagree, assume that
clinical assessment is correct
 Trends are generally more important than a single reading
 Use non-invasive techniques when possible
 Alarms are crucial for child safety

11. Types of monitoring system
 Monitoring the respiratory system.
 Monitoring the cardiovascular system.

12. I. Monitoring the respiratory system.

13. Monitoring the respiratory system.
1) Pulse oximeter:
 It’s non invasive method of measuring the arterial oxygen saturation.
 The intensity of light after passing through the tissue is measured by
photodiode.
 The absorption by the tissues & non pulsatile element is assumed to be
contrast, the pulsatile arterial flow gives variable absorption.
 The oxygen saturation is estimated from the ratio of the difference in these
measurements at the two wavelength of the light.
 This is useful method of non invasive oxygen monitoring in children with
cardio respiratory disease.

14. 2) Transcutaneous oxygen monitoring.

15. 2) Transcutaneous oxygen monitoring
 Transcutaneous oximetry, tcpO2 or TCOM, is a local, noninvasive
measurement reflecting the amount of oxygen that has diffused from
the capillaries through the epidermis
 Transcutaneous oxygen and carbon dioxide monitoring, originally
developed for neonatal use, has become a routine measurement in
several clinical areas including:
 Determination of peripheral vascular oxygenation
Quantification of the degree of peripheral vascular disease
 Evaluation of revascularization procedures

16. 3) Transcutaneous carbon dioxide
monitoring
 The sensor used to measure transcutaneous carbon dioxide comprises a
sensitive glass & sliver chloride electrode.
 skin surface CO2 measurement reflect peripheral gas tension & not arterial
tension.
 The value is influenced by both ventilating & hemodynamic changes.
 Transcutaneous carbon dioxide (TcCO2) monitoring is a non-invasive
alternative to arterial blood sampling

17. 4) The apnea monitor
 It’s simple pneumograph which picks up the chest wall movements
allows the graphic & the rate display.
 This may be useful when used in conjunction with pulse oximeter.
 This will alert the staff to the presence of respiratory irregularities which
may herald respiratory insufficiency.

19. Capnography
Capnography:-
 End-tidal CO2 concentration is close to artrial PaCO2 levels.
 Indicates the adequacy of alveolar ventilation.

20. Inspired oxygen tension:-
Modern ventilation has oxygen monitors incorporated in the machine with
automatic alarm system.
CONT.

21. Chest
Anatomy.
Inspection: symmetry, movement of chest wall.
Breathing pattern- abdominal breathing.
Palpation
1- Light palpation: in light circular motion to detect
lesion and masses.
2- Deep palpation: palpate for internal organ like liver
and spleen.

22. Cont.
 Start from breast, lymph nodes, and pulses.
 Use back of hand to assess temp.
 Use palm to assess vibration.
 Assess respiratory excursion during insp. and exp.
 Posterior assessment at the level of spinal column at
the level of 10th ribs.
Percussion of the chest
 put patient in supine position, or in side.
 Percussion : record what you hear.

23. Cont.
Auscultation
Used to assess the flow of air through the bronchial tree
and to evaluate the presence of fluid or solid in lung
structure.
Anterior-axillary line.
Mid-clavicular line.
Mid-sternal line.
Posterior axillary line.
Scapular line.
Vertebral line.
Use stethoscope and move from side to side.

26. Chest Assessment
Retractions
Subcostal.
Intercostal.
Sub-sternal.
Supra-clavicular.
Red flags
grunting / nasal flaring.

27. Possible Sites of Retractions
Observe while infant
or child is quiet.

28. Monitoring the cardio vascular
system
 ECG monitor:-
 Standard three leads monitoring is most useful.
 Heart rate is the main contributor to the cardiac
output.

29. CONT.
 Cardiac Output (CO)
 Usually measured by thermodilution PA catheter.
 Can also be measured by dye dilution, transesophageal Doppler, echo,
or impedence plethysmography.
 EKG
 Monitors rate and rhythm of heart.

30. Monitoring the cardio vascular
system
Blood pressure monitoring:-
 It’s the product of the cardiac output & systemic vascular resistance .It’s
determines the perfusion of the vital organ, i.e. brain, heart, liver &
kidney.
 It can be measured by invasive & non –invasive methods.
Non –invasive monitoring:-
 It’s include the occlusion of the artery most often the brachial artery.

31. invasive monitoring:-
 Monitoring gives useful information regarding the intravascular volume &
right sided filing pressure.
 But in certain condition values obtained may be incorrect as the tricuspid
regurgitation.
CONT.

32. Heart examination
Palpation over four area
■1- Aortic area: felt in the 2nd ICS to the RT. Of sternum.
■2- Pulmonary area: felt in the 2nd ICS to the LT. of the
sternum.
■3- Rt. Ventricular or Tricuspid area- felt in 5th ICS.
■4- Mitral area: felt in the 5th ICS to the Lt. of the
sternum under nipple.

33. Cont.
Apical impulse best felt at the Lt. MCL and 4th
ICS for child under 7th year.
At the Lt. MCL and 5th ICS for child above 7th
year.
Auscultation of the heart: S1, S2, S3.

35. Assess heart sound

36. Heart Sounds

37. Computers in SICU
Use computers almost universally for the following purposes:-
 To acquire physiological data frequently or continuously, such as blood
pressure readings.
 To communicate information from data-producing systems to remote
locations (for example, laboratory and radiology departments).
 To store, organize, and report data.
 To integrate and correlate data from multiple sources.

38. CONT.
To provide clinical alerts and advisories based on multiple
sources of data.
To function as a decision-making tool that health professionals may
use in planning then care of critically ill children.
To measure the severity of illness for child classification
purposes.
To analyze the outcomes of SICU care in terms of clinical
effectiveness and cost-effectiveness.

39. Use of computers for patient monitoring.
Automatic
control
Patient
equipment
Computer
Reports
Mouse and
keyboard
Display
Transducers
Clinician

40. SICU
Bed Bed Bed
Bed
Nurse station
Telemetry
WEB
connection

41. Some instruments in mind

42. CONT.

43. New advance

44. 44
Thank you