monitoring hemodinamik
DESCRIPTION
Fisologi kardiovaskulerTRANSCRIPT
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MONITORING HEMODINAMIK
SECARAINVASIF & NON INVASIF
Dr. Muharriansyah, Dr. Khalikul Razi & Dr. Nasrul Haidi
Dr. Yopie Afriandi Habibie, Sp.BTKV
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Jantung dan Fungsinya
Heart Rate: Jantung berdenyut (N) 60-80 x/menit
Stroke Volume: tiap denyut dipompakan rata-rata 70 cc Cardiac output = Stroke volume x Heart rate Cardiac Index = Cardiac output Body surface area
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Faktor yang mempengaruhi kerja jantung:
1. Preload2. Kontractility myocard3. Afterload4. Heart rate.
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1. Preload
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2. Contractility
• Contractility =Inotropic• Chronotropic = frekwensi denyut
jantung• EF (ejection fraction) = EDV – ESV
EDV
Nilai normal 66-70%
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3. Afterload
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Profil Hemodinamik
• Blood Pressure: Sistolik, Diastolik, MAP• CVP ( Central Venous Pressure )• PAP ( Pulmonary Arteri Presure)• PCWP (Pulmonary Capilary Wedge
Pressure)• Cardiac Output• Cardiac Index• SVR (Sistemic Vascular Resisten)• PVR( Pulmonal Vascccular Resisten)
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• CVP ( Central Venous Pressure ): 4-10 mm Hg• PAP ( Pulmonary Arteri Presure): 9 – 16 mm Hg• Pulmonary Capilary Wedge Pressure:5-12mm Hg• Cardiac Output :4-6 liter• Cardiac Index : 2,8 – 4,2 liter/ menit.• SVR (Sistemic Vascular Resisten) : 900 –1400 dyne
sec cm-5• PVR( Pulmonal Vascular Resisten):150 –250 dyne
sec cm-5
Nilai Normal:
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Hemodinamik Monitoring
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I. Arteri line
• Pasang canulasi pada arteri, monitor blood pressure continue terlihat pada layar monitor.
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2. CVP• Indikasi:
* Bila infus vena sulit* Mengukur CVP* Iritasi drug:- vasokontriktor (dopamin,Levoped)- TPN ( total Parentral Nutrisi)- Penempatan Pulmonaary kateter- Penempatan Temporary Pacemaker
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Letak * Vena Jugularis Interna * Vena subclavia * Vena femoralis
Komplikasi:* Pneumothorax, Hematothorax, Empyema subcutis* Ventricle aritmia bila terdorong terlalu dalam* Emboli* Thrombophlebitis* Infeksi dan perdarahan
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Swanz Ganz (PA kateter)
• Dapat mengukur:* Pulmonary Artery pressure* Cardiac output* Mixed vein Saturation* Hemodynamic Profile
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• Komplikasi:* Sama seperti komplikasi CVP* Tertusuk myocard* Valvular damage* Pulmonary artery injury/rupture * Pulmonary infark* Kateter malposisi ke dalam ventricle kanan menyumbat Arteri Pulmonal permanen.
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Dr. Muharriansyah, Dr. Khalikul Razi & Dr. Nasrul Haidi