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Arterial Line Set-up and Hemodynamic Monitoring

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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  1. Presented by: Jonna Bobeck BSN, RN, CEN Arterial Line Set-up and Hemodynamic Monitoring

  2. Objectives • Define blood pressure • Discuss indications • Describe contraindications • Identify equipment • Define procedural steps • Discuss Complications

  3. Introduction • Direct monitoring of systolic, diastolic, and mean arterial pressures • Highly accurate • Waveform reflects pressure

  4. Blood Pressure

  5. Systolic Blood Pressure

  6. Diastolic Blood pressure

  7. Mean Arterial Pressure (MAP) • MAP = CO X total peripheral resistance MAP =[ SBP + (DBP x 2)] 3 • Importance of measuring MAP

  8. Calculate MAP: 120/80 100 93 87 65

  9. Calculate MAP: 90/56 98 54 67 65

  10. Factors Affecting Blood Pressure • Rate of pumping • Volume • Resistance • viscosity

  11. 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

  12. 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

  13. Insertion Equipment

  14. Procedure • Site selection • Explain procedure • Obtain consent • Proper hand hygiene • Modified Allen test

  15. 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

  16. What is the Correct Heparin Concentration? 25,000 units in D5W 10,000 units/ml 1000 units in 500 ml 5000 units/ml

  17. Level of Right Atrium (phleobostatic axis)

  18. Square Box Test(The DynamicResponse)

  19. Monitoring the Waveform

  20. Troubleshooting Waveform • Overdamped • Underdamped

  21. 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

  22. 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

  23. Complications • Air embolism • Severe blood loss • Dampened wave form • infection • Median nerve damage • Clot formation • hematoma

  24. Patient Teaching • Use care • Report dampness, redness, pain, or warmth

  25. Documentation • Education • Peripheral and neurovascular assess • Insertion site • Response • Alarms and parameters • Flush solution • Waveform • Unexpected outcomes

  26. ED Nurse Ready for Action!

  27. 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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