Hemodynamic monitoring
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Hemodynamic monitoring involves measuring pressures, flows, and oxygen levels within the cardiovascular system both invasively and non-invasively. Invasive monitoring includes measuring systemic and pulmonary arterial pressures, central venous pressure, pulmonary artery wedge pressure, and venous and arterial oxygen saturations. Non-invasive monitoring includes pulse oximetry and arterial blood gas analysis. Invasive arterial pressure monitoring uses an arterial catheter and transducer to continuously measure blood pressure and is used to guide treatment for conditions like shock, respiratory failure, or during procedures. Pulmonary artery catheters can be used to measure pressures and oxygen saturations in the heart and lungs to guide fluid management and treatment of conditions like acute respiratory distress syndrome or heart failure. Comp
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Hemodynamic monitoring in ICU
This document discusses hemodynamic monitoring in pediatrics. It begins with definitions of hemodynamics and hemodynamic monitoring. Both invasive and noninvasive monitoring methods are described, including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheterization. Complications of invasive methods are outlined. Normal hemodynamic parameters for children are provided. The document emphasizes the importance of hemodynamic monitoring in critically ill children to guide treatment and optimize tissue perfusion and oxygen delivery.
Hemodynamic monitoring
This document discusses hemodynamic monitoring, which involves measuring the pressure, flow, and oxygenation of blood within the cardiovascular system. It describes both noninvasive and invasive methods of hemodynamic monitoring. Noninvasive methods include measuring vital signs like blood pressure and heart rate, while invasive methods involve placing catheters in the central circulation to directly measure pressures. Specific invasive monitoring techniques covered are arterial line placement, central venous pressure monitoring via a central line, and pulmonary artery catheterization to measure pressures and determine cardiac output. Normal ranges for various hemodynamic parameters are also provided.
Hemodynamic monitoring
Hemodynamic monitoring- Hemodynamic monitoring refers to the measurement of pressure, flow and oxygenation within the cardiovascular system. Hemodynamic monitoring is amandatory process in all the critical care units to assess the patients progress. This presentation is aimed to create an insight on Hemodynamic monitoring.
Hemodynamic monitorig
Hemodynamic monitoring involves assessing the movement of blood through the cardiovascular system. There are non-invasive and invasive methods, with the pulmonary artery catheter allowing for direct measurement of central venous pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac output, and mixed venous oxygen saturation. Placement of the pulmonary artery catheter carries risks of complications but provides valuable hemodynamic data that can guide diagnosis and management of critically ill patients.
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This document provides information on arterial line insertion and monitoring. It discusses indications for arterial lines, equipment needed, insertion techniques, complications, and troubleshooting. The radial artery is typically used as it has a low complication rate and is superficial, allowing for easy compression if needed. Continuous monitoring of arterial waveforms is important to ensure accurate blood pressure readings and detect any issues. Troubleshooting involves assessing the waveform, equipment, and catheter placement to address potential problems like dampening or resonance in the tracing.
Iabp
The intra-aortic balloon pump (IABP) is a mechanical device that increases coronary blood flow and reduces cardiac workload by inflating and deflating in sync with the cardiac cycle. It has a flexible catheter inserted into the femoral artery connected to a console that controls helium delivery. The balloon inflates in diastole to boost diastolic pressure and deflates in systole to reduce afterload. This improves cardiac output and oxygen delivery while decreasing oxygen demand. IABP is used in heart failure, unstable angina, cardiogenic shock, and high-risk cardiac procedures as a bridge to recovery or surgery. Nursing care involves monitoring for complications like bleeding, infection and limb ischemia.
INTRA AORTIC BALLON PUMP (IABP)
1) Intra-aortic balloon counterpulsation (IABP) provides systolic unloading and diastolic augmentation to improve cardiac output.
2) IABP is indicated for cardiogenic shock, high-risk PCI/CABG, and mechanical complications.
3) Potential complications include limb ischemia, infection, bleeding, and aortic injury.
4) Optimal IABP waveform analysis and timing are important to maximize hemodynamic support.
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, representing ventricular ejection; the dicrotic notch, indicating aortic and pulmonary valve closure; and stroke volume variance seen with respiration. Proper waveform analysis guides fluid and pressor management.
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Hemodynamic monitoring in ICU
This document discusses hemodynamic monitoring in pediatrics. It begins with definitions of hemodynamics and hemodynamic monitoring. Both invasive and noninvasive monitoring methods are described, including arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheterization. Complications of invasive methods are outlined. Normal hemodynamic parameters for children are provided. The document emphasizes the importance of hemodynamic monitoring in critically ill children to guide treatment and optimize tissue perfusion and oxygen delivery.
Hemodynamic monitoring
This document discusses hemodynamic monitoring, which involves measuring the pressure, flow, and oxygenation of blood within the cardiovascular system. It describes both noninvasive and invasive methods of hemodynamic monitoring. Noninvasive methods include measuring vital signs like blood pressure and heart rate, while invasive methods involve placing catheters in the central circulation to directly measure pressures. Specific invasive monitoring techniques covered are arterial line placement, central venous pressure monitoring via a central line, and pulmonary artery catheterization to measure pressures and determine cardiac output. Normal ranges for various hemodynamic parameters are also provided.
Hemodynamic monitoring
Hemodynamic monitoring- Hemodynamic monitoring refers to the measurement of pressure, flow and oxygenation within the cardiovascular system. Hemodynamic monitoring is amandatory process in all the critical care units to assess the patients progress. This presentation is aimed to create an insight on Hemodynamic monitoring.
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Hemodynamic monitoring involves assessing the movement of blood through the cardiovascular system. There are non-invasive and invasive methods, with the pulmonary artery catheter allowing for direct measurement of central venous pressure, pulmonary artery pressure, pulmonary artery occlusion pressure, cardiac output, and mixed venous oxygen saturation. Placement of the pulmonary artery catheter carries risks of complications but provides valuable hemodynamic data that can guide diagnosis and management of critically ill patients.
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Iabp
The intra-aortic balloon pump (IABP) is a mechanical device that increases coronary blood flow and reduces cardiac workload by inflating and deflating in sync with the cardiac cycle. It has a flexible catheter inserted into the femoral artery connected to a console that controls helium delivery. The balloon inflates in diastole to boost diastolic pressure and deflates in systole to reduce afterload. This improves cardiac output and oxygen delivery while decreasing oxygen demand. IABP is used in heart failure, unstable angina, cardiogenic shock, and high-risk cardiac procedures as a bridge to recovery or surgery. Nursing care involves monitoring for complications like bleeding, infection and limb ischemia.
INTRA AORTIC BALLON PUMP (IABP)
1) Intra-aortic balloon counterpulsation (IABP) provides systolic unloading and diastolic augmentation to improve cardiac output.
2) IABP is indicated for cardiogenic shock, high-risk PCI/CABG, and mechanical complications.
3) Potential complications include limb ischemia, infection, bleeding, and aortic injury.
4) Optimal IABP waveform analysis and timing are important to maximize hemodynamic support.
Arterial line analysis
1) An arterial line allows continuous monitoring of a patient's blood pressure by connecting an arterial catheter to a pressure transducer. The transducer converts pressure oscillations into an electrical waveform displayed on a monitor.
2) The arterial waveform provides information about cardiovascular physiology and hemodynamics. An accurate waveform depends on proper catheter placement, monitoring equipment setup, and avoiding issues like dampening or resonance.
3) Key portions of the arterial waveform include the anacrotic limb, representing ventricular ejection; the dicrotic notch, indicating aortic and pulmonary valve closure; and stroke volume variance seen with respiration. Proper waveform analysis guides fluid and pressor management.
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Temporary cardiac pacing is used to treat acute bradyarrhythmias or tachyarrhythmias until the underlying condition resolves or permanent pacing can be initiated. It aims to re-establish normal hemodynamics compromised by abnormal heart rates. Transvenous pacing is the preferred method, involving insertion of endocardial leads through veins to the heart. Precise lead placement is important and is confirmed with imaging. Pacing parameters like threshold, rate and sensing are optimized. Complications include those related to vascular access and device malfunction requiring troubleshooting. Close monitoring is needed to ensure proper pacing and detect any issues.
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Cvp
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This document provides an overview of arterial blood pressure monitoring. It discusses the history and development of non-invasive blood pressure measurement techniques. It then focuses on the components, principles, and technical aspects of invasive arterial blood pressure monitoring using an intra-arterial catheter connected to a transducer system. Key points covered include the components of the measuring system, optimizing the system's natural frequency and damping, and the importance of zeroing and leveling the transducer.
1 Monitoring of Central Venous Pressure & Its Techniques
This document discusses monitoring central venous pressure through central venous catheters. It describes the types of central lines, their indications and contraindications, and techniques for insertion. Factors that affect central venous pressure are outlined, as are methods to measure pressure directly through transducers or indirectly by inspecting jugular veins. The document interprets central venous pressure waveforms and describes how pressure changes with respiration.
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CVP monitoring involves inserting a catheter into a large central vein and connecting it to a pressure monitoring device to measure central venous pressure. CVP provides information about right ventricular function and intravascular volume status. It is used to guide fluid resuscitation and assess the effectiveness of treatments for conditions like heart failure. Key steps in CVP monitoring include positioning the patient supine, zeroing the monitoring device at the level of the right atrium, and observing pressure waveforms and readings to evaluate volume status and cardiac function. Nurses are responsible for assessing the catheter site for complications and maintaining the sterility and function of the CVP monitoring system.
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This document provides information about central venous cannulation and central venous pressure (CVP) measurement. It discusses the indications, contraindications, sites, techniques, and complications of central venous cannulation. The internal jugular vein and subclavian vein are described as common sites. Ultrasound guidance can help with visualization and decreases complications rates. CVP is measured by connecting a manometer to the central line and observing the fluid level, with normal ranges being from 3-8 cmH2O. Peripherally inserted central catheters are also discussed as an alternative approach.
Hemodynamic monitoring
Hemodynamic monitoring involves measuring the motion of blood through the body and interpreting how the cardiovascular system is performing. The goal is optimizing oxygen delivery. Key metrics include cardiac output, arterial and venous oxygen levels, and oxygen delivery and consumption. Common monitoring methods are non-invasive blood pressure, arterial catheters, central venous pressure, pulmonary artery catheters, and pulse oximetry. Each method has advantages and limitations for assessing hemodynamics and tissue oxygenation. Careful interpretation of the data is important for clinical decision making.
Transesophageal echocardiography(TEE)
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Central venous pressure
This document discusses central venous pressure (CVP), including indications for CVP monitoring, measurement, waveform interpretation, and techniques for central venous cannulation. It notes that CVP can be used to assess intravascular volume status, right ventricular function, and is indicated for major procedures involving fluid shifts. The internal jugular vein and subclavian vein are common access sites, and ultrasound guidance can help with cannulation. Potential complications include arterial puncture, pneumothorax, and infection.
IABP
The document summarizes information about the intra-aortic balloon pump (IABP), which is a circulatory assist device used to support the left ventricle through counterpulsation. It describes how the IABP works by inflating and deflating a balloon catheter timed to the cardiac cycle to displace aortic blood. It provides details on patient criteria, device set-up, monitoring, complications, and weaning from the IABP.
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This document provides information about a seminar on hemodynamic monitoring presented by UMAdevi.k. It discusses the purpose of hemodynamic monitoring in critically ill patients, which is to continuously assess the cardiovascular system and diagnose/manage complex medical conditions. Specific techniques covered include arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter pressure monitoring. Key aspects of each technique like indications, equipment, procedures, nursing responsibilities, and potential complications are defined. Normal hemodynamic values are also provided.
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Pacemaker
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
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The document discusses temporary pacemakers, including their uses, common settings, potential complications, and care/maintenance. Temporary pacemakers are used to stimulate the heart in the absence of an intrinsic rhythm or to supplement an inadequate rhythm. Common settings include AAI, VVI, and DDD. Complications include failure to pace or sense, and care involves cleaning and securing insertion sites and leads while monitoring for proper pacing.
Can we be intensive and non-invasive? by Professor Michael Pinsky
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The goal of hemodynamic monitoring is to assess the cardiovascular state of the patient, define their reserve and monitor response to treatments and time. Resuscitation efforts are essentially aimed at restoring and sustaining tissue wellness through maintaining an adequate amount of oxygenated blood flow to the metabolically active tissues. We need to monitor pressure, flow and function. To accomplish these goals one must be able to measure arterial pressure and all its components (i.e. waveforms), cardiac output and stroke volume as well as the adequacy of flow. Presently, there are several devices that can estimate the arterial pressure waveform from a finger plethysmographic device. They are very accurate until profound circulatory collapse makes peripheral pulse not representative of central pressures. These devices can also estimate stroke volume by intuiting the arterial pressure waveform in a fashion similar to that performed by the numerous minimally invasive hemodynamic monitoring devices we now have now. These non-invasive devices can quantify functional hemodynamic monitoring dynamic parameters. Also, pulse oximeter pleth density signals vary with pulse volume into the finger or skin and the pleth variability can also be used as a surrogate of pulse pressure variation. Furthermore, bioreactance can measure both cardiac output and intrathoracic fluid content through surface electrodes. Finally, end-tidal CO2 transiently varies with venous return, increasing if blood flow increases. So both eh bioreactance device and end-tidal CO2 can be used to identify cardiac output changes in response to a passive leg raising maneuver. Thus, one can measure arterial pressure waveforms and cardiac output continuously, assess volume responsiveness and monitor therapy. Finally, the dynamic changes in tissue O2 saturation (StO2) measured by near infrared spectroscopy of the thenar eminence during a vascular occlusion test defines peripheral circulatory insufficiency and local blood flow independent of arterial pressure. Furthermore, heart rate variability decreases with increasing cardiovascular stress and can be readily measured in real time from the R-R intervals of the surface ECG signal. Finally, the measure of urine output, skin temperature and sensorium all define effective tissue blood flow as reasonable end-points to resuscitation, if the patient is not overwhelmingly ill. When these measures are coupled to a treatment approach know to improve outcome, there is little reason to believe that such completely non-invasive approaches will be inferior to invasive ones in the management of the critically ill patient. Hemodynamic Pressure Monitoring
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
Lec # 6 hemodynamic monitoring
Hemodynamic monitoring involves measuring various cardiovascular parameters at the bedside, including blood pressures, heart rate, cardiac output, and volumes. It provides important information to guide treatment for critically ill patients. The document discusses several hemodynamic monitoring methods and parameters in detail, such as arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring using catheters and transducers. It also covers topics like indications for hemodynamic monitoring, potential complications, and nursing considerations.
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Temporary cardiac pacing
Temporary cardiac pacing is used to treat acute bradyarrhythmias or tachyarrhythmias until the underlying condition resolves or permanent pacing can be initiated. It aims to re-establish normal hemodynamics compromised by abnormal heart rates. Transvenous pacing is the preferred method, involving insertion of endocardial leads through veins to the heart. Precise lead placement is important and is confirmed with imaging. Pacing parameters like threshold, rate and sensing are optimized. Complications include those related to vascular access and device malfunction requiring troubleshooting. Close monitoring is needed to ensure proper pacing and detect any issues.
Pericardiocentesis
Pericardiocentesis is a procedure to remove fluid from the pericardium, the sac surrounding the heart. It is used diagnostically and therapeutically to treat cardiac tamponade, a dangerous buildup of fluid in the pericardium that reduces heart function. The procedure involves inserting a needle under ultrasound or echocardiogram guidance to drain the fluid. Risks include puncturing the heart or blood vessels. It provides rapid relief of symptoms for tamponade but the fluid must be analyzed to determine the underlying cause.
Cvp
Central venous pressure (CVP) is measured using an indwelling central venous catheter and manometer or transducer. CVP provides information about circulating blood volume and cardiac function. Normal CVP is 5-10 cm H2O. CVP is commonly measured in intensive care to guide fluid management in critically ill patients. Potential complications include infection, hemorrhage, catheter occlusion or displacement. Accurate CVP measurement requires proper patient positioning and use of manometers or transducers at the phlebostatic axis.
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This document provides an overview of arterial blood pressure monitoring. It discusses the history and development of non-invasive blood pressure measurement techniques. It then focuses on the components, principles, and technical aspects of invasive arterial blood pressure monitoring using an intra-arterial catheter connected to a transducer system. Key points covered include the components of the measuring system, optimizing the system's natural frequency and damping, and the importance of zeroing and leveling the transducer.
1 Monitoring of Central Venous Pressure & Its Techniques
This document discusses monitoring central venous pressure through central venous catheters. It describes the types of central lines, their indications and contraindications, and techniques for insertion. Factors that affect central venous pressure are outlined, as are methods to measure pressure directly through transducers or indirectly by inspecting jugular veins. The document interprets central venous pressure waveforms and describes how pressure changes with respiration.
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Comprehensive presentation on intra arterial blood pressure with a good insight into the the basic physics and brief look into the risks and complications.
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This is a very simple presentation prepared for nurses. It will help nurses to understand the need of monitoring and the available methods. The presentation has been constructed on a clinical case base scenario and gradually different methods of monitoring has been introduced.
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cvp monitoring
CVP monitoring involves inserting a catheter into a large central vein and connecting it to a pressure monitoring device to measure central venous pressure. CVP provides information about right ventricular function and intravascular volume status. It is used to guide fluid resuscitation and assess the effectiveness of treatments for conditions like heart failure. Key steps in CVP monitoring include positioning the patient supine, zeroing the monitoring device at the level of the right atrium, and observing pressure waveforms and readings to evaluate volume status and cardiac function. Nurses are responsible for assessing the catheter site for complications and maintaining the sterility and function of the CVP monitoring system.
Central venous cannulation
This document provides information about central venous cannulation and central venous pressure (CVP) measurement. It discusses the indications, contraindications, sites, techniques, and complications of central venous cannulation. The internal jugular vein and subclavian vein are described as common sites. Ultrasound guidance can help with visualization and decreases complications rates. CVP is measured by connecting a manometer to the central line and observing the fluid level, with normal ranges being from 3-8 cmH2O. Peripherally inserted central catheters are also discussed as an alternative approach.
Hemodynamic monitoring
Hemodynamic monitoring involves measuring the motion of blood through the body and interpreting how the cardiovascular system is performing. The goal is optimizing oxygen delivery. Key metrics include cardiac output, arterial and venous oxygen levels, and oxygen delivery and consumption. Common monitoring methods are non-invasive blood pressure, arterial catheters, central venous pressure, pulmonary artery catheters, and pulse oximetry. Each method has advantages and limitations for assessing hemodynamics and tissue oxygenation. Careful interpretation of the data is important for clinical decision making.
Transesophageal echocardiography(TEE)
A transesophageal echocardiogram, or TEE, is an alternative way to perform an echocardiogram. A specialized probe containing an ultrasound transducer at its tip is passed into the patient's esophagus. This allows image and Doppler evaluation which can be recorded. It has several advantages and some disadvantages compared with a transthoracic echocardiogram.
Central venous pressure
This document discusses central venous pressure (CVP), including indications for CVP monitoring, measurement, waveform interpretation, and techniques for central venous cannulation. It notes that CVP can be used to assess intravascular volume status, right ventricular function, and is indicated for major procedures involving fluid shifts. The internal jugular vein and subclavian vein are common access sites, and ultrasound guidance can help with cannulation. Potential complications include arterial puncture, pneumothorax, and infection.
IABP
The document summarizes information about the intra-aortic balloon pump (IABP), which is a circulatory assist device used to support the left ventricle through counterpulsation. It describes how the IABP works by inflating and deflating a balloon catheter timed to the cardiac cycle to displace aortic blood. It provides details on patient criteria, device set-up, monitoring, complications, and weaning from the IABP.
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Coronary artery bypass grafting (CABG) is a surgical procedure that improves blood flow to the heart. During CABG, a healthy blood vessel is grafted to bypass blocked coronary arteries and restore blood flow to the heart muscle. The internal thoracic artery, radial artery, and saphenous vein are common graft conduits. The procedure requires general anesthesia and opening the chest via median sternotomy. Grafts are sewn to the coronary arteries above and below the blockages to reroute blood flow around them. Post-operative care focuses on monitoring for bleeding, arrhythmias, and other complications. Nursing care involves assessing the patient, providing wound care, managing pain, and educating on lifestyle changes and
Hemodynamic monitoring ppt
This document provides information about a seminar on hemodynamic monitoring presented by UMAdevi.k. It discusses the purpose of hemodynamic monitoring in critically ill patients, which is to continuously assess the cardiovascular system and diagnose/manage complex medical conditions. Specific techniques covered include arterial blood pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter pressure monitoring. Key aspects of each technique like indications, equipment, procedures, nursing responsibilities, and potential complications are defined. Normal hemodynamic values are also provided.
Haemodynamic monitoring during cpb
This document discusses hemodynamic monitoring components used to evaluate the cardiovascular system. It describes how components such as heart rate, blood pressure, cardiac output, stroke volume, central venous pressure and pulmonary artery pressures are measured and used to establish baseline values, evaluate trends, determine dysfunction, and guide interventions. Factors that influence hemodynamics like preload, afterload, contractility and resistance are also explained. Normal ranges for various measurement values are provided.
Pacemaker
A pacemaker is an electronic device that provides electrical stimulation to the heart muscle. Pacemakers were first developed in the 1950s and have since become implantable devices used to treat conditions like sinus node dysfunction and heart block. There are permanent and temporary pacemakers that can be single chamber, dual chamber, or multisite devices. Pacemakers are implanted surgically and connected to the heart with leads to provide pacing in the appropriate chambers. Nursing care involves preoperative teaching, postoperative monitoring for complications, assessing pacemaker function, and educating patients.
Temporary pacing
The document discusses temporary pacemakers, including their uses, common settings, potential complications, and care/maintenance. Temporary pacemakers are used to stimulate the heart in the absence of an intrinsic rhythm or to supplement an inadequate rhythm. Common settings include AAI, VVI, and DDD. Complications include failure to pace or sense, and care involves cleaning and securing insertion sites and leads while monitoring for proper pacing.
Can we be intensive and non-invasive? by Professor Michael Pinsky
Can we be intensive and non-invasive? by Professor Michael PinskyCICM 2019 Annual Scientific Meeting
The goal of hemodynamic monitoring is to assess the cardiovascular state of the patient, define their reserve and monitor response to treatments and time. Resuscitation efforts are essentially aimed at restoring and sustaining tissue wellness through maintaining an adequate amount of oxygenated blood flow to the metabolically active tissues. We need to monitor pressure, flow and function. To accomplish these goals one must be able to measure arterial pressure and all its components (i.e. waveforms), cardiac output and stroke volume as well as the adequacy of flow. Presently, there are several devices that can estimate the arterial pressure waveform from a finger plethysmographic device. They are very accurate until profound circulatory collapse makes peripheral pulse not representative of central pressures. These devices can also estimate stroke volume by intuiting the arterial pressure waveform in a fashion similar to that performed by the numerous minimally invasive hemodynamic monitoring devices we now have now. These non-invasive devices can quantify functional hemodynamic monitoring dynamic parameters. Also, pulse oximeter pleth density signals vary with pulse volume into the finger or skin and the pleth variability can also be used as a surrogate of pulse pressure variation. Furthermore, bioreactance can measure both cardiac output and intrathoracic fluid content through surface electrodes. Finally, end-tidal CO2 transiently varies with venous return, increasing if blood flow increases. So both eh bioreactance device and end-tidal CO2 can be used to identify cardiac output changes in response to a passive leg raising maneuver. Thus, one can measure arterial pressure waveforms and cardiac output continuously, assess volume responsiveness and monitor therapy. Finally, the dynamic changes in tissue O2 saturation (StO2) measured by near infrared spectroscopy of the thenar eminence during a vascular occlusion test defines peripheral circulatory insufficiency and local blood flow independent of arterial pressure. Furthermore, heart rate variability decreases with increasing cardiovascular stress and can be readily measured in real time from the R-R intervals of the surface ECG signal. Finally, the measure of urine output, skin temperature and sensorium all define effective tissue blood flow as reasonable end-points to resuscitation, if the patient is not overwhelmingly ill. When these measures are coupled to a treatment approach know to improve outcome, there is little reason to believe that such completely non-invasive approaches will be inferior to invasive ones in the management of the critically ill patient. What's hot (20)
1 Monitoring of Central Venous Pressure & Its Techniques
1 Monitoring of Central Venous Pressure & Its Techniques
Can we be intensive and non-invasive? by Professor Michael Pinsky
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Hemodynamic Pressure Monitoring
This document discusses hemodynamic pressure monitoring, including indirect and invasive arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery catheter placement and measurements. It provides details on:
- Methods for continuously monitoring arterial blood pressure, heart rate, and circulatory function during anesthesia
- Techniques for indirect and direct arterial pressure measurement
- Components, calibration, and placement of arterial pressure monitoring catheters
- Measurements obtained from central venous and pulmonary artery catheters like cardiac output, pressures, and oxygen saturation
- Potential complications of pulmonary artery catheter placement
Lec # 6 hemodynamic monitoring
Hemodynamic monitoring involves measuring various cardiovascular parameters at the bedside, including blood pressures, heart rate, cardiac output, and volumes. It provides important information to guide treatment for critically ill patients. The document discusses several hemodynamic monitoring methods and parameters in detail, such as arterial pressure monitoring, central venous pressure monitoring, and pulmonary artery pressure monitoring using catheters and transducers. It also covers topics like indications for hemodynamic monitoring, potential complications, and nursing considerations.
Haemodynamic monitoring
Central and arterial lines are catheters used to provide venous or arterial access. Central lines terminate in the superior vena cava or right atrium, while arterial lines are placed in peripheral arteries like the radial artery. They are used to administer fluids/drugs, monitor pressures, or obtain blood samples. Complications include infection, bleeding, air embolism, and thrombosis. When managing patients with lines, nurses monitor for complications, secure connections, and remove lines per indications to prevent issues.
Advanced Hemodynamics
This document provides an introduction to hemodynamic monitoring, which involves measuring factors that influence blood flow and pressure. It defines hemodynamic monitoring and outlines its purposes, which include diagnosing and managing shock states, determining fluid status, and measuring cardiac output. The document discusses indications for hemodynamic monitoring as well as contraindications for invasive pulmonary artery catheters. It also reviews important hemodynamic values and concepts, pulmonary artery catheter insertion and positioning, waveform analysis, and removal of pulmonary artery catheters.
Hemodynamics
Hemodynamic monitoring measures factors that influence the force and flow of blood in order to aid in diagnosing, monitoring, and managing critically ill patients. It involves using pulmonary artery catheters and transducers to obtain pressures and other cardiovascular measurements that provide information on conditions like shock states and help guide treatment decisions. Potential risks and complications require careful use of these monitoring techniques in appropriate clinical situations.
Hemodynamics Basic Concepts
1. The purpose of invasive hemodynamic monitoring is to detect and treat life-threatening conditions such as heart failure and cardiac tamponade by evaluating a patient's cardiovascular function and response to treatment.
2. Indications for hemodynamic monitoring include decreased cardiac output from various causes, shock, loss of cardiac function, and coronary artery disease.
3. A pulmonary artery catheter allows for continuous monitoring of pressures, flows, oxygen saturation and calculation of cardiac output, and helps precisely manage fluid balance and hemodynamics.
Hemodynamic monitoring- Dr Sandeep Gampa
This document discusses hemodynamic monitoring in critically ill patients. It notes that while hemodynamic monitoring is a cornerstone of management, the utility of most methods is unproven. Physicians have become psychologically dependent on feedback from monitors independent of their effectiveness. The effectiveness of monitoring is limited to specific patient groups and diseases where proven effective treatments exist. The document discusses various hemodynamic monitoring methods including invasive and non-invasive options like arterial catheters, central venous pressure, and echocardiography. It notes that no individual parameter necessarily defines hemodynamic stability and thresholds vary between patients and clinical contexts.
Hemodynamic Monitoring
Hemodynamic monitoring involves the invasive measurement of pressures within the heart and vessels to assess cardiovascular function and tissue perfusion. It utilizes a catheter connected to a transducer and monitor. Catheters can be placed in the pulmonary artery via the jugular or subclavian vein, in the right atrium, or in arteries like the radial or femoral. This allows the direct measurement of pressures in these areas to guide treatment for issues like shock. Complications can include infections, arrhythmias, or embolisms, so the insertion site must be carefully monitored.
01 tuong phan
The document discusses advances in minimally invasive cardiac output monitoring technologies. It describes several technologies including oesophageal Doppler, arterial pressure waveform analysis, pulse contour analysis, pulse oximetry plethysmography, and their respective advantages. Key parameters provided include stroke volume, cardiac output, and respiratory variation indices. While accuracy varies between methods, respiratory coupled parameters have been shown to predict fluid responsiveness. Overall, minimally invasive cardiac output monitoring provides useful haemodynamic data but outcomes depend on how clinicians utilize the information to guide care.
Advances in haemodynamic monitoring
Hemodynamic monitoring has advanced with new equipment allowing continuous, non-invasive monitoring of key parameters. Pulse contour analysis uses an arterial catheter to provide beat-to-beat measurements used to calculate stroke volume, cardiac output, and contractility. Thermodilution techniques inject cold saline to measure parameters like intrathoracic blood volume, extravascular lung water, and ejection fraction. Echocardiography non-invasively assesses cardiac structure and function. These advances allow early detection and guided therapy for shock.
Taurus SC Insecticide / Termiticide
Taurus SC Insecticide / Termiticide - 20 oz. is a water based suspension concentrate of 9.1% fipronil for pre and post termite control. Applied at a 0.8 fluid ounces per gallon (0.06% dilution) for most applications. http://www.pestmall.com/taurus-sc-insecticide-termiticide-20-oz.html
MHS On the Horizon 12-13 final smallpdf
This document is the 2012-2013 annual report for Marin Horizon School. It includes the following:
1) Letters from the Head of School, Board Chair, and Parent Association President discussing initiatives to increase revenue and enrollment, as well as thanking the community for their support.
2) Highlights from events of the past year like the Wine Tasting & Boutique night and 35th Birthday Art Auction which raised $178,000 for the school.
3) Updates on learning programs, alumni, the 200 year history of the school, and donor listings.
En the purpose_of_creation
God created humans for a specific purpose according to divine revelation. Without knowing this purpose, humans risk wasting their existence on meaningless pursuits and losing eternal reward. While philosophers have speculated on the purpose of creation, clear answers are only found in revealed scripture. The Old Testament provides some context but does not fully answer why humans were created. The author will explore both the divine and human perspectives on creation based on revelation from God's prophets to provide the correct understanding of humanity's purpose.
Time table of postcall case presentations.
This document outlines the schedule of case presentations and journal clubs to be held by board students during September and October 2012. It lists the date, presenter, and topic for each session. Case presentations and death conferences will be led by different resident doctors each time. Journal clubs involve presentations on recent medical journal articles and are led by various resident doctors. The purpose is to discuss patient cases, mortality reviews, and recent research findings. Consultants may attend case discussions and death conferences.
Catalyst Insecticide - Pint
Catalyst insecticide is highly recommended for hard infestation . Since, the soluble product contains a synthetic material in water, creating a long-term residue which does not stain. The catalyst is a non-repellent insecticide, which provides a quick knockdown to target parasites.
T g servicio de al@nia
El documento describe el servicio Al@nia de la Universidad del Atlántico, el cual permite a los estudiantes realizar trámites académicos y financieros en línea a través de Internet. Al@nia ofrece servicios como actualización de datos, solicitud de certificados, gestión académica, gestión financiera y admisiones especiales. El sistema busca mejorar el tiempo de respuesta a las solicitudes de los estudiantes y facilitar los trámites universitarios sin necesidad de hacer filas presencialmente.
Virtual poster presentation
1) The document evaluates the effectiveness of insulin pumps in reducing hemoglobin A1c (HbA1c) levels in patients with type 2 diabetes compared to conventional treatment methods through a literature review.
2) The literature findings show that insulin pumps may be more effective at reducing HbA1c levels, but the strength of evidence varies and limitations exist.
3) More high-quality randomized controlled studies over longer periods are needed to provide stronger evidence about the effectiveness of insulin pumps.
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This document provides information on the management of cardiogenic shock. It begins with a case presentation of a 72-year-old male brought to the emergency department with sudden onset chest pain and symptoms of shock. It then defines cardiogenic shock and discusses its causes, risk factors, diagnosis, and treatment modalities. Treatment involves managing reversible causes, vasopressors, mechanical support like intra-aortic balloon pumps or ventricular assist devices, and permanent measures such as fibrinolysis, revascularization, or transplantation. The document reviews various hemodynamic support devices and their indications.
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Hemodynamic monitoring measures factors that influence blood flow and pressure. It aids in diagnosing, monitoring, and managing critically ill patients by measuring things like cardiac output, fluid status, and the body's response to therapies. The document discusses the components, placement, and use of pulmonary artery catheters to obtain important hemodynamic measurements, as well as how to interpret the results and optimize cardiac output in critical care patients. Potential complications of PA catheters are also reviewed.
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A lecture highlighting the role of Echocardiography as a major hemodynamic monitoring tool in the Intensive Care settings and the assessment of loading conditions.
Xavier Monnet - Monitoring hd pi cco java porto - IFAD 2012
This document discusses hemodynamic monitoring techniques to guide treatment for patients with hemodynamic failure. It describes using the PiCCO device to noninvasively monitor parameters such as cardiac output, lung water content, contractility, and fluid responsiveness to determine whether a patient needs vasopressors, volume expansion, inotropes, and when to stop fluid administration. Tests like pulse pressure variation, end-expiratory occlusion, and passive leg raising used with continuous cardiac output monitoring can predict fluid responsiveness, while extravascular lung water and pulmonary vascular permeability index measurements help avoid excessive fluid loading and lung injury.
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The document provides information on pulmonary hypertension and pulmonary circulation. It discusses:
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This document discusses central venous catheters and invasive arterial blood pressure monitoring. It provides information on indications for central lines and arterial catheters including venous access and infusion of irritant drugs. Complications of lines include infection, bleeding, embolism and organ perforation. The document describes how to insert and care for lines, including using ultrasound guidance and maintaining asepsis. It also discusses interpreting central venous pressure and issues like incorrect transducer positioning. Arterial monitoring is described along with complications like thrombosis and embolism."
Arterial_and_CVP_monitoring.ppt
Central venous catheters and arterial lines are inserted to monitor central venous pressure, administer fluids/medications, and obtain arterial blood gas samples. Central lines are most commonly placed in the internal jugular or subclavian veins while arterial lines are usually placed radially. Precise positioning of transducers is important for accurate pressure readings. Potential complications include infection, bleeding, arrhythmias, and embolism. Careful insertion and maintenance can reduce risks.
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The document discusses the pulmonary artery catheter, including its history, parts, specifications, insertion technique, measurements, complications, and indications. Some key points:
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- It has multiple ports and a balloon at the tip that can be inflated to obtain pulmonary capillary wedge pressure measurements.
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This document provides an overview of hemodynamic monitoring. It discusses various techniques for measuring pressure, including invasive arterial blood pressure monitoring and central venous pressure. Cardiac output can be monitored invasively using thermodilution or dye dilution, or noninvasively using pulse contour analysis. Volume status and fluid responsiveness can be assessed by measuring variables affected by preload such as pulse pressure variation. Tissue perfusion can be evaluated using near-infrared spectroscopy to measure tissue oxygen saturation or by analyzing lactate levels. The goal of hemodynamic monitoring is to achieve adequate organ perfusion while minimizing interventions, requiring use of multiple monitoring tools and integrating clinical findings.
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Non-invasive haemodynamic monitoring by Echocardiography
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This document provides information on nursing care for patients with renal or bladder cancer. It discusses the types, signs and symptoms, and treatments for both renal and bladder cancers. It also outlines important nursing considerations for pre-operative, post-operative, and long-term care of patients undergoing surgery, chemotherapy, or radiation therapy for these cancers. Teaching points are also included to help patients understand their diagnoses, treatments, and self-care after being discharged.
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Renal calculi, or kidney stones, form when substances normally dissolved in urine precipitate. Risk factors include dehydration, urinary tract infections, abnormal urine pH, immobilization, and certain metabolic disorders. Symptoms include severe flank pain radiating to the groin (renal colic), nausea, vomiting, fever and hematuria. Treatment involves vigorous hydration, antibiotics, pain medications, and procedures to remove or break up stones depending on size. Nursing care focuses on monitoring fluid intake and output, administering medications, and educating patients on preventative diet and lifestyle changes.
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Nephrotic syndrome is a kidney disorder defined by proteinuria, edema, hyperlipidemia, and hypoalbuminemia. It is caused by primary kidney diseases or secondary systemic diseases like diabetes. Clinical manifestations include edema, malnutrition, irritability, immunosuppression, and respiratory infections. Diagnosis involves testing urine and blood to confirm nephrotic-range proteinuria, hypoalbuminemia, and hyperlipidemia. Treatment focuses on corticosteroid therapy, diuretics, diet management, activity levels, and preventing infection. Nursing care monitors fluid balance, improves nutrition, promotes skin integrity, conserves energy, and prevents infection.
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Continuous renal replacement therapy (CRRT) provides continuous dialysis treatment for patients with acute renal failure who cannot tolerate traditional intermittent hemodialysis. CRRT works around the clock to provide stable therapy without dangerous electrolyte and hemodynamic changes. There are various CRRT methods that differ in complexity, including continuous venovenous hemodialysis (CVVHD) where blood is pumped through a hemofilter to remove waste and fluids. CRRT requires vascular access via a catheter and uses pumps, hemofilters, replacement fluids, and dialysate to continuously clean and filter the blood. Nursing responsibilities for CRRT include monitoring vitals, equipment, lines, medications, schedules, and managing complications.
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Acute renal injury, also known as acute renal failure, can develop suddenly in hospitalized patients and is classified as prerenal, intrarenal, or postrenal. Prerenal failure results from decreased blood flow to the kidneys, intrarenal failure damages the kidneys directly, and postrenal failure involves urine outflow blockage. Treatment focuses on identifying and reversing causes, maintaining fluid and electrolyte balance, and initiating dialysis for severe cases. Nursing care monitors for complications and educates patients on diet, medications, symptom reporting and managing the condition.
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This document discusses malignant melanoma and melasma. Malignant melanoma arises from melanocytes and can spread through the lymphatic and vascular systems. There are four main types of melanoma. Treatment may include surgical resection, chemotherapy, and radiation. Nurses should provide education and support to patients. Melasma is a patchy hyperpigmentation disorder that commonly affects females and may be related to hormones or sun exposure. Patients should take steps to limit sun exposure and use sunscreen.
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Rosacea is a chronic skin condition causing flushing and pimple-like lesions on the face. Risk factors include light skin, age 30-50, and stress. Symptoms include redness, pimples, and thickened skin on the nose. Treatment focuses on avoiding triggers and using oral antibiotics or topical metronidazole.
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Both conditions require protecting skin from
Dermatitis
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Aplastic and hypoplastic anemias result from stem cell or bone marrow damage, causing low red blood cell, white blood cell, and platelet production. They can develop from drugs, toxins, radiation, viruses, or unknown causes. Symptoms include fatigue, shortness of breath, and easy bruising. Treatment focuses on blood transfusions, immunosuppressants, bone marrow transplant, and managing infections. Iron deficiency anemia, another common type, results from inadequate iron intake or absorption and causes similar symptoms. Replacement with oral or intravenous iron is the typical treatment.
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This document summarizes the evolution of nursing from ancient times to the present. It discusses how nursing began with women providing care at home based on humanitarian principles with no formal training. Nursing became more organized over time, with many orders developing in the Medieval period to care for the sick and poor. Modern nursing was greatly advanced by Florence Nightingale in the 1800s through establishing nursing training standards. Nursing continued to professionalize globally in the late 1800s/early 1900s. The document outlines the development of nursing education and regulation in India over time, noting it has progressed significantly but more improvements are still needed.
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Test bank clinical nursing skills a concept based approach 4e pearson education一比一原版布里斯托大学毕业证(Bristol毕业证书)学历如何办理
补办文凭【微信号:176555708】【(Bristol毕业证书)】【微信号:176555708】《成绩单、外壳、offer、真实留信官方学历认证（永久存档/真实可查）》采用学校原版纸张、特殊工艺完全按照原版一比一制作（包括：隐形水印，阴影底纹，钢印LOGO烫金烫银，LOGO烫金烫银复合重叠，文字图案浮雕，激光镭射，紫外荧光，温感，复印防伪）行业标杆！精益求精，诚心合作，真诚制作！多年品质 ,按需精细制作，24小时接单,全套进口原装设备，十五年致力于帮助留学生解决难题，业务范围有加拿大、英国、澳洲、韩国、美国、新加坡，新西兰等学历材料，包您满意。
【我们承诺采用的是学校原版纸张（纸质、底色、纹路）我们拥有全套进口原装设备，特殊工艺都是采用不同机器制作，仿真度基本可以达到100%，所有工艺效果都可提前给客户展示，不满意可以根据客户要求进行调整，直到满意为止！】
【业务选择办理准则】
一、工作未确定，回国需先给父母、亲戚朋友看下文凭的情况，办理一份就读学校的毕业证【微信号:176555708】文凭即可
二、回国进私企、外企、自己做生意的情况，这些单位是不查询毕业证真伪的，而且国内没有渠道去查询国外文凭的真假，也不需要提供真实教育部认证。鉴于此，办理一份毕业证【微信号:176555708】即可
三、进国企，银行，事业单位，考公务员等等，这些单位是必需要提供真实教育部认证的，办理教育部认证所需资料众多且烦琐，所有材料您都必须提供原件，我们凭借丰富的经验，快捷的绿色通道帮您快速整合材料，让您少走弯路。
留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
7:个人信誉贷款加10分
8:在国家人才网主办的国家网络招聘大会中纳入资料，供国家高端企业选择人才
留信网服务项目：
1、留学生专业人才库服务（留信分析）
2、国（境）学习人员提供就业推荐信服务
3、留学人员区块链存储服务
【关于价格问题（保证一手价格）】
我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
选择实体注册公司办理，更放心，更安全！我们的承诺：客户在留信官方认证查询网站查询到认证通过结果后付款，不成功不收费！
VEDANTA AIR AMBULANCE SERVICES IN REWA AT A COST-EFFECTIVE PRICE.pdf
Air Ambulance Services In Rewa works in close coordination with ground-based emergency services, including local Emergency Medical Services, fire departments, and law enforcement agencies.
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一比一原版(UoA毕业证)昆士兰科技大学毕业证如何办理
UoA毕业证学历书【微信95270640】办文凭{昆士兰科技大学毕业证}Q微Q微信95270640UoA毕业证书成绩单/学历认证UoA Diploma未毕业、挂科怎么办？+QQ微信：Q微信95270640-大学Offer（申请大学）、成绩单（申请考研）、语言证书、在读证明、使馆公证、办真实留信网认证、真实大使馆认证、学历认证
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Health Tech Market Intelligence Prelim Questions -
The Ultimate Guide to Setting up Market Research in Health Tech part -1
How to effectively start market research in the health tech industry by defining objectives, crafting problem statements, selecting methods, identifying data collection sources, and setting clear timelines. This guide covers all the preliminary steps needed to lay a strong foundation for your research.
This lays foundation of scoping research project what are the
Before embarking on a research project, especially one aimed at scoping and defining parameters like the one described for health tech IT, several crucial considerations should be addressed. Here’s a comprehensive guide covering key aspects to ensure a well-structured and successful research initiative:
1. Define Research Objectives and Scope
Clear Objectives: Define specific goals such as understanding market needs, identifying new opportunities, assessing risks, or refining pricing strategies.
Scope Definition: Clearly outline the boundaries of the research in terms of geographical focus, target demographics (e.g., age, socio-economic status), and industry sectors (e.g., healthcare IT).
3. Review Existing Literature and Resources
Literature Review: Conduct a thorough review of existing research, market reports, and relevant literature to build foundational knowledge.
Gap Analysis: Identify gaps in existing knowledge or areas where further exploration is needed.
4. Select Research Methodology and Tools
Methodological Approach: Choose appropriate research methods such as surveys, interviews, focus groups, or data analytics.
Tools and Resources: Select tools like Google Forms for surveys, analytics platforms (e.g., SimilarWeb, Statista), and expert consultations.
5. Ethical Considerations and Compliance
Ethical Approval: Ensure compliance with ethical guidelines for research involving human subjects.
Data Privacy: Implement measures to protect participant confidentiality and adhere to data protection regulations (e.g., GDPR, HIPAA).
6. Budget and Resource Allocation
Resource Planning: Allocate resources including time, budget, and personnel required for each phase of the research.
Contingency Planning: Anticipate and plan for unforeseen challenges or adjustments to the research plan.
7. Develop Research Instruments
Survey Design: Create well-structured surveys using tools like Google Forms to gather quantitative data.
Interview and Focus Group Guides: Prepare detailed scripts and discussion points for qualitative data collection.
8. Sampling Strategy
Sampling Design: Define the sampling frame, size, and method (e.g., random sampling, stratified sampling) to ensure representation of target demographics.
Participant Recruitment: Plan recruitment strategies to reach and engage the intended participant groups effectively.
9. Data Collection and Analysis Plan
Data Collection: Implement methods for data gathering, ensuring consistency and validity.
Analysis Techniques: Decide on analytical approaches (e.g., statistical
nursing management of patient with Empyema ppt
prepared by Prof. BLESSY THOMAS, SPN
Empyema is a disease of respiratory system It is defines as the accumulation of thick, purulent fluid within the pleural space, often with fibrin development.
Empyema is also called pyothorax or purulent pleuritis.
It’s a condition in which pus gathers in the area between the lungs and the inner surface of the chest wall. This area is known as the pleural space.
Pus is a fluid that’s filled with immune cells, dead cells, and bacteria.
Pus in the pleural space can’t be coughed out. Instead, it needs to be drained by a needle or surgery.
Empyema usually develops after pneumonia, which is an infection of the lung tissue. it is mainly caused due in infectious micro-organisms. It can be treated with medications and other measures.
Fit to Fly PCR Covid Testing at our Clinic Near You
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UNIT PERKEMBANGAN PROFESYEN PPP
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留信网认证的作用:
1:该专业认证可证明留学生真实身份
2:同时对留学生所学专业登记给予评定
3:国家专业人才认证中心颁发入库证书
4:这个认证书并且可以归档倒地方
5:凡事获得留信网入网的信息将会逐步更新到个人身份内，将在公安局网内查询个人身份证信息后，同步读取人才网入库信息
6:个人职称评审加20分
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我们所定的价格是非常合理的，而且我们现在做得单子大多数都是代理和回头客户介绍的所以一般现在有新的单子 我给客户的都是第一手的代理价格，因为我想坦诚对待大家 不想跟大家在价格方面浪费时间
对于老客户或者被老客户介绍过来的朋友，我们都会适当给一些优惠。
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Hemodynamic monitoring
- 1. Hemodynamic monitoring ALBERT BLESSON MEDICAL SURGICAL NURSE
- 2. Hemodynamic data Refers to the measurement of pressure , flow and oxygen within cardiovascular system Invasive and non invasive Systemic and pulmonary arterial pressure CVP PAWP Sao2 Svo2 Intergart with clinical data
- 4. Principles of invasive pressure monitoring Measure systemic and pulmonary blood pressures Cather, Pressure tubing, Flush system, Transducer. Positions Explain the procedure Position supine an flat , elevated up to 45 degree Confirm the zero reference Observe the monitor End expiration
- 6. zero point
- 7. transducer
- 9. Types of invasive pressure monitoring Arterial blood pressure Pulmonary artery flow directed catheter
- 10. Arterial blood pressure Acute hypertension Hypotension Respiratory failure Shock Neurological injury Coronary interventional procedures Continuous infusion of vasoactive drugs Frequent ABG
- 11. ABP 20 g , 2 inch(5.1 cm) Non tapered Teflon catheter Peripheral line(radial, femoral) Suture after insertion Systolic and diastolic and mean blood pressure Measurement obtained at end expiration
- 12. complication Risk of hemorrhage---( dislodged)– luerlock connection, arterial waveform, alarm system Infection(inspect the site)—(change the set ever 96 hours) thrombus formation (circulatory impairment)---( allen test before catheter insertion) ---to prevent flush every 1-4 hours (pressure bag inflated to 300 mm hg)---- flush bag delivers fluid 3 to 6 ml per hour( heparinized saline) Neurovascular impairment –assess hourly—cool and pale—capillary refill greater 3 seconds(tingling, pain or paresthesia)
- 13. Clinical indication for pulmonary artery ARDS ARF Cardiac tamponade Circulatory syndrome IABP Major trauma Burn injury MI Shock Hypotension – no response to fluid resucitations
- 14. Pulmonary artery flow directed catheter Guide ( complicated cardiac ,pulmonary and intravascular volume problems PAD and PAWP indicators of cardiac function Pressure increased in fluid overload and decrease in depletion PA therapeutic manipulation and to maintain CO without risk of pulmonary edema PA –SWAN CATHETER 7.5 French 43 inches (110 cms) with four and five lumens
- 15. catheter
- 17. Pulmonary catheter insertion Patient electrolyte( risk for ventricular dysrhythmia),Acid base balance, Oxygen, Coagulation status ( chance of hemorrhage) Prepare monitor set Phlebostatic axis Supine position Informed consent Internal jugular ,subclavian, antecubital or femoral vein Waveform in monitor guide Inflate balloon (RA)—1 TO 1.5 ML RA - RV - PA Monitor ECG Deflate balloon when tracing PAWP Chest x ray Secure the catheter and apply dressing
- 18. CVP OR Right artery pressure Cvp measure right ventricular preload( proximal lumen) Internal jugular vein or subclavian vein Cvp measured in end expiration Its reflects fluid volume Elevated indicates right ventricular failure Low cvp indicates hypovolemia
- 19. Invasive CO Normal resting CO is 4 to 8 l/mt and CI is 2.2 to 4 lt/min/m2 Varies in size CO and CI is decreased in shock and increased in exercise, early sepsis and fever Thermistor sensor in distal measure blood temperature
- 20. Venous oxygen saturation Svo2 and scvo2 Normal – 60 to 80 % High – 80 to 95% Low less than 60%
- 21. Complication od PA Infection and sepsis( infection control protocol) Air embolus – injection ,balloon rupture – nurse should check for blood r air back flow in balloon port Risk for pulmonary infarction(balloon rupture, obstruct blood flow, thrombosis formation) Balloon not inflated more than 1.5 ml of air Balloon inflated must not be inflated for more than 4 breaths or 8-15 sec Thrombus ( prevent by flushing) Ventricular dysrhythmia ( cneck an repositioned) 0
- 22. Non invasive arterial oxygen monitoring Pulse oximetry ABG ANALYSIS
- 23. NURSES ROLE GENERAL APPERANCE LEVEL OF CONCSCIOUS SKIN COLOR TEMPERATURE VITAL SIGNS URINE OUTPUT PHERIPHERAL PULSE
- 24. THANK YOU