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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