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.
Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.
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
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
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
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
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.