Perfusion

1. Perfusion Guest Lecture: Associate Professor WCU Amy Putnam, RN, MSN

2. Perfusion • Exemplar is circulation assessment • Objectives for this lecture are to follow…

3. Perfusion • Describe factors affecting perfusion. • Relate the physiological process involved in circulation and perfusion. • Assess the client’s perfusion status through the health history and physical exam of the cardiovascular system. • Describe the basic diagnostic and laboratory test utilized to determine the client’s perfusion status.

4. Perfusion • This begins with the lungs’ ability to distribute the erythrocytes or red blood cells to and from the pulmonary capillaries • We will focus on the cardiovascular aspect of perfusion, but remember that the cardiovascular system and the respiratory system work together in the body

5. Perfusion • Typically if a client has a disease process involving the lungs, the cardiovascular system will also be affected, thus affecting perfusion

6. Perfusion • Arterial blood pressure is a good indicator of cardiovascular health, and thus perfusion • Blood pressure, and thus the body’s ability to perfusion tissue is affected by: • Cardiac output, peripheral vascular resistance, blood volume, blood viscosity, and artery elasticity

7. Perfusion: cardiac output • When volume increases in a blood vessel, the pressure in the space rises • As cardiac output increases, the blood pressure rises • There is a direct correlation between cardiac output and blood pressure, thus perfusion of tissue

8. Perfusion: Cardiac Output • Cardiac Output: increases due to increased heart rate, • greater heart contractility, • or an increase in blood volume • A rapid or significant increase in heart rate decreases the heart’s filling time, so there is a decrease in blood pressure

9. Perfusion: Peripheral Resistance • Arteries and arterioles are covered by smooth muscle that adjusts the lumen size as needed, depending on tissue needs • The smaller the vessel lumen, the higher the peripheral vascular resistance

10. Perfusion: Blood Volume • Circulating blood volume in adults is about 5000 mL • Increase in blood volume, increase in blood pressure: IV infusion • Decrease in blood volume, decrease in blood pressure: hemorrhage

11. Perfusion: Viscosity • Thickness of the blood • Hematocrit: percentage of blood cells in the blood determines viscosity

12. Perfusion: Elasticity • Normally arterial walls are elastic • Reduced elasticity: greater resistance to blood flow

13. Pulse and Perfusion • Palpable bounding of blood flow at various points in the body • Good indicator of circulatory status and thus perfusion • Page 521 chart for pulse sites • If pulse is present, there is some level of vascular perfusion of tissue

14. Assessment of Tissue Perfusion • Palpation of pulse sites and grading on page 605 • Assess condition of skin, mucosa, nail beds • Color of skin, lips, mouth, and conjunctivae

15. Assessment • Inspect lower extremities for changes of color, temperature, and condition of the skin • Ask about history of leg pain • Skin and nail texture, hair distribution on lower legs, feet, and toes

16. Assessment • Palpate the legs and feet for color and temperature • Assess capillary refill: blanching the nail bed for several seconds • When pressure is released, full color should return in less than 2 seconds

17. Reminders • The heart and lungs work together to perfuse the body • Assessment depends on the area in question