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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

Presented by:

Jonna Bobeck BSN, RN, CEN

Arterial Line Set-up and Hemodynamic Monitoring


Objectives

Objectives

  • Define blood pressure

  • Discuss indications

  • Describe contraindications

  • Identify equipment

  • Define procedural steps

  • Discuss Complications


Introduction

Introduction

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

  • Highly accurate

  • Waveform reflects pressure


Blood pressure

Blood Pressure


Systolic blood pressure

Systolic Blood Pressure


Diastolic blood pressure

Diastolic Blood pressure


Mean arterial pressure map

Mean Arterial Pressure (MAP)

  • MAP = CO X total peripheral resistance

    MAP =[ SBP + (DBP x 2)]

    3

  • Importance of measuring MAP


Calculate map 120 80

Calculate MAP: 120/80

100

93

87

65


Calculate map 90 56

Calculate MAP: 90/56

98

54

67

65


Factors affecting blood pressure

Factors Affecting Blood Pressure

  • Rate of pumping

  • Volume

  • Resistance

  • viscosity


Indications

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

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

Insertion Equipment


Procedure

Procedure

  • Site selection

  • Explain procedure

  • Obtain consent

  • Proper hand hygiene

  • Modified Allen test


Procedure continued

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

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

Level of Right Atrium (phleobostatic axis)


Square box test the dynamic response

Square Box Test(The DynamicResponse)


Monitoring the waveform

Monitoring the Waveform


Troubleshooting waveform

Troubleshooting Waveform

  • Overdamped

  • Underdamped


An overdamped waveform causes

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

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

Complications

  • Air embolism

  • Severe blood loss

  • Dampened wave form

  • infection

  • Median nerve damage

  • Clot formation

  • hematoma


Patient teaching

Patient Teaching

  • Use care

  • Report dampness, redness, pain, or warmth


Documentation

Documentation

  • Education

  • Peripheral and neurovascular assess

  • Insertion site

  • Response

  • Alarms and parameters

  • Flush solution

  • Waveform

  • Unexpected outcomes


Ed nurse ready for action

ED Nurse Ready for Action!


References

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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