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Arterial Line Set-up and Hemodynamic Monitoring PowerPoint PPT Presentation


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Presented by: Jonna Bobeck BSN, RN, CEN. Arterial Line Set-up and Hemodynamic Monitoring. Objectives. Define blood pressure Discuss indications Describe contraindications Identify equipment Define procedural steps Discuss Complications. Introduction.

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Arterial Line Set-up and Hemodynamic Monitoring

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Presented by:

Jonna Bobeck BSN, RN, CEN

Arterial Line Set-up and Hemodynamic Monitoring


Objectives

  • Define blood pressure

  • Discuss indications

  • Describe contraindications

  • Identify equipment

  • Define procedural steps

  • Discuss Complications


Introduction

  • Direct monitoring of systolic, diastolic, and mean arterial pressures

  • Highly accurate

  • Waveform reflects pressure


Blood Pressure


Systolic Blood Pressure


Diastolic Blood pressure


Mean Arterial Pressure (MAP)

  • MAP = CO X total peripheral resistance

    MAP =[ SBP + (DBP x 2)]

    3

  • Importance of measuring MAP


Calculate MAP: 120/80

100

93

87

65


Calculate MAP: 90/56

98

54

67

65


Factors Affecting Blood Pressure

  • Rate of pumping

  • Volume

  • Resistance

  • viscosity


Indications

  • Monitor arterial pressure continuously and accurately

  • To monitor response of vasoactive drugs

  • Facilitate frequent sampling of lab specimens

  • To determine derived hemodynamic parameters such as MAP


Cautions and Contraindications

  • Knowledge and understanding of A-lines

  • Potential for significant blood loss if tubing becomes disconnected

  • Close patient monitoring

  • Avoid insertion into injured extremities


Insertion Equipment


Procedure

  • Site selection

  • Explain procedure

  • Obtain consent

  • Proper hand hygiene

  • Modified Allen test


Procedure Continued

  • Gather equipment

  • Attach transducer to Philips monitor and set scale

  • Prepare pressure tubing with heparin

    1000 units per 500 ml

  • Set up and level transducer

  • Check manual BP

  • Set alarms and scale appropriately


What is the Correct Heparin Concentration?

25,000 units in D5W

10,000 units/ml

1000 units in 500 ml

5000 units/ml


Level of Right Atrium (phleobostatic axis)


Square Box Test(The DynamicResponse)


Monitoring the Waveform


Troubleshooting Waveform

  • Overdamped

  • Underdamped


An Overdamped Waveform Causes?

Your patient’s systolic pressure to be inaccurately low

Your patient’s blood pressure to be accurate

Overdamped is rare and is not of any concern

Your patient’s systolic pressure to be inaccurately high


An Underdamped Waveform Causes?

Your patient’s systolic pressure to be inaccurately low

Your patient’s blood pressure to be accurate

Overdamped is rare and is not of any concern

Your patient’s systolic pressure to be inaccurately high


Complications

  • Air embolism

  • Severe blood loss

  • Dampened wave form

  • infection

  • Median nerve damage

  • Clot formation

  • hematoma


Patient Teaching

  • Use care

  • Report dampness, redness, pain, or warmth


Documentation

  • Education

  • Peripheral and neurovascular assess

  • Insertion site

  • Response

  • Alarms and parameters

  • Flush solution

  • Waveform

  • Unexpected outcomes


ED Nurse Ready for Action!


References

  • Lynne-MChaleWiegard, D., Carlson, K., Initials. (Ed.). (2001). AACN procedure manual for critical care. United States: Elsevier Saunders.

  • Proehl, J. (Ed.). (2004). Emergency nursing procedures. United States: Elsevier Saunders.


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