5/24/2015 1 hemodynamic monitoring. objective 5/24/2015 2 1. describe the three attributes of...
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HEMODYNAMIC MONITORING
OBJECTIVE
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1. Describe the three attributes of circulating blood and their relationships.
2. Identify types of clients in which hemodynamic monitoring would be
indicated.
3. Describe the types of catheters used for hemodynamic monitoring.
4. Discuss the normal and abnormal values obtained through hemodynamic monitoring as they relate to specific client
situations.
5. List the potential complications in use of hemodynamic monitoring
devices.
6. Explain nursing responsibilities when caring for patient on hemodynamic monitoring.
7. Describe the procedure for setting up a hemodynamic circuit.
HEMODYNAMIC MONITORING
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DEFINITION:Using invasive technology to provide quantitative information about vascular
capacity, blood volume; pump effectiveness, and tissue perfusion
HEMODYNAMIC MONITORING
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ATTRIBUTES OF CIRCULATING BLOOD: 1. PRESSURE 2. RESISTANCE 3. Flow
HEMODYNAMIC MONITORING
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TYPES OF CATHETERS USED FOR HEMODYNAMIC MONITORING: 1. Pulmonary Artery Catheter (swan
ganz)
2. Arterial Pressure Catheters
3. Central Venous Pressure or CVP monitoring
HEMODYNAMIC MONITORING
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INDICATIONS FOR HEMODYNAMIC MONITORING:
1. Potential or actual alteration in CO
2. Potential or actual alteration in fluid
volume
HEMODYNAMIC MONITORING
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PULMONARY ARTERY MONITORING EQUIPMENT
1. Invasive catheter (swan ganz) 2. Transducer 3. Amplifier/recorder
HEMODYNAMIC MONITORING
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SWAN GANZ CATHETER
a. Distal Lumen: the PA (pulmonary artery)b. Proximal Lumen: (CVP port) c. Inflation Balloon D. Thermostat Lumene. Additional Lumens * VIP - venous infusion port
* Pacing Port-
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HEMODYNAMIC MONITORING
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Assessment Data, Pressures, Waveforms of the swan ganz catheter
a. RAP or CVP b. PAP - c. PCWP (PAWP) d. Waveforms: RAP, RVP, PAP, PCWP e. Using Pressures to Calculate Other
Hemodynamic Variables * CO, CI, MAP, SVR, PVR
HEMODYNAMIC MONITORING
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NURSING RESPONSIBILITIES 1. Pre-Insertion: a. Patient & significant others
teaching. b. Thorough baseline assessment
c. Equipment set-upd. Positioning of the cliente. Equipment check (calibration, zero
etc.)
HEMODYNAMIC MONITORING
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NURSING RESPONSIBILITIES 2. Insertion, (patient is often awake for the procedure)
a. Collaboration b. Assist with equipment preparationc. Monitor patients response to treatmente. Recording
HEMODYNAMIC MONITORING
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NURSING RESPONSIBILITIES 3. Post-Insertion a. Chest X-ray for placemenb. Sterile OCCLUSIVE dressing,
stabilization of the catheterc. Patient comfortd. Assess and document pressures/datae. Catheter maintenancef. Monitor patients response
HEMODYNAMIC MONITORING
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NURSING RESPONSIBILITIES Maintenance of the System: a. Label and date lines, change tubing as per unit policy b. Maintain & change dressing c. Alert for waveform and pressure changes d. Maintain pressure/pressure bag e. Keep balloon deflated between PCWP readings
f. Collaboration and communication with physician
g. Remember to care for the patient as well as your equipment
HEMODYNAMIC MONITORING
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POTENTIAL COMPLICATIONS 1. Dysrhythmias
2. Infection 3. Pneumothorax4. Pulmonary infarction 5. Balloon rupture and air embolism6. Pulmonary artery rupture
7. Endocarditis
HEMODYNAMIC MONITORING
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ARTERIAL PRESSURE MONITORING: 1. Indications 2. Assessment data: * MAP = (diastolic x 2)+(systolic)
3
* MAP - ICP = CPP
HEMODYNAMIC MONITORING
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ARTERIAL PRESSURE MONITORING:3. Arterial Waveform a. Aortic valve opens and blood is ejected
from LV and is recorded as an increase in pressure
b. Highest point represents systole
c. Lowest point is diastolic pressure
HEMODYNAMIC MONITORING
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ARTERIAL PRESSURE MONITORING:4. Nursing Responsibilities5. Potential Complications: a. Thrombosis at catheter tip
b. Infection c. Bleeding d. Loss of flow distal to extremity
Nursing Responsibilities
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Prepare the setup and the circuitsAssist in the procedure Caring for equipments as well as for the
patient.CalibrationObtaining the readingsInterpreting the results and informing the
physicianProviding the suitable managementDocumenting
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Swan Ganz Cathetarization
PROCEDURE FOR SETTING UP A HOMODYNAMIC CIRCUIT
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Equipment Required: 1. 2 single transducer kit 2. 2 Pressure bags
3. 2 500 mL bag of .9 NaCl with1,000 units of
heparin 4. 2 transducer clamp 5. 2 pressure cable connected to Protocol
monitor
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