1 / 99

HAEMODYNAMIC MONITORING ( IABP, CVP, CO )

HAEMODYNAMIC MONITORING ( IABP, CVP, CO ). Al jadidi S ulaiman Moderator: Dr Nik Azman. Haemodynamic monitoring. It is the measurement of haemodynamic status Haemodynamic status is an index of pressure & flow within cardiovascular system – pulmonary & systemic circulations.

dewei
Download Presentation

HAEMODYNAMIC MONITORING ( IABP, CVP, CO )

An Image/Link below is provided (as is) to download presentation 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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. HAEMODYNAMIC MONITORING( IABP, CVP, CO ) Al jadidiSulaiman Moderator: DrNikAzman

  2. Haemodynamic monitoring.. • It is the measurement of haemodynamic status • Haemodynamic status is an index of pressure & flow within cardiovascular system – pulmonary & systemic circulations

  3. Introduction • Haemodynamic measurement are important to establish – precise diagnosis - determine appropriate therapy - monitor response to therapy • Extent of monitoring depends on how much data is required to optimisept’s condition, & how precisely data is to be recorded

  4. Purpose of monitoring.. • Early detection, identification, and treatment of life-threatening conditions such as heart failure and cardiac tamponade • Evaluate the patient’s immediate response to treatment such as drugs and mechanical support • Evaluate the effectiveness of cardiovascular function such as cardiac output and index

  5. Rationale for haemodynamic monitoring • Previous experience using similar monitoring technique was shown to be beneficial • Next level – understanding the pathophysiology of process being treated, such as heart failure or hypovolemic shock

  6. Indication (1)Diagnostic • causes of patient’s pathophysiological condition (2)Therapeutic • base on the index & clinical situation, specific therapy & treatments are prescribed (3)Research • assess efficacy of new therapy

  7. Any deficit or loss of cardiac function: such as AMI,CHF,Cardiomyopathy • All types of shock;cardiogenic,neurogenic,oranaphylactic • Decreased urine output from dehydration, hemorrhage,G.I. bleed,burns,or surgery

  8. Type of monitoring.. Invasive • Arterial pressure monitoring • Central venous pressure monitoring • Pulmonary artery pressure monitoring • cardiac output • pulse contour cardiac output Non-invasive • ECG • Non-invasive blood pressure • Pulse oximetry • Tissue perfusion • temperature • mentation • Urine output • Echocardiogram & Doppler

  9. Invasive pressure monitor • Access to an artery or vein • catheter connected to fluid filled pressure tubing & pressure transducer • connected to bedside monitor • continuous & accurate • fluctuation: positional • calibration drift • leveling • different sites

  10. Calibration of equipment • For accurate Haemodynamic pressure readings, two baseline measurements are necessary: 1. Calibration of the system to atmospheric pressure 2. Determination of the phlebostatic axis for transducer height placement

  11. Zeroing the equipment • To zero the equipment, turn 3-way stopcock open to air (atmospheric pressure), close to patient and flush system. The monitor is adjusted so that “0” is displayed, which equals atmospheric pressure. • Return the stopcock to original position to visualize the waveform and haemodynamic pressures. • zero once every 8 hours.

  12. Phlebostatic Axis • Left atrium - reference point on the chest • Used as a baseline for consistent transducer height placement. • Obtaining the axis involves drawing a line from the fourth intercostal space, where it joins the sternum, to a mid-axillary line. • The intersection of these lines approximates the level of the atria.

  13. Leveling.. • The transducer air-reference stopcock is leveled with this reference point to obtain accurate patient haemodynamic pressure.

  14. Arterial Pressure Monitoring • Cannulation of an artery & attaching the catheter to a fluid-filled transducer system • Continuous assessment of arterial perfusion to the major organ systems of the body.

  15. Indication • Direct arterial blood pressure monitoring enables accurate continuous pressure measurement. • Allow easy blood sampling for acid-base and other measurements.

  16. Arterial Line Insertion And Sites • Usually the radial artery cannulation is used. • Other most common sites are dorsalispedis, brachial, femoral arteries. • Allen’s test should be performed before a catheter is inserted into the radial artery to ensure the presence of adequate collateral circulation to the hand by the ulnar artery.

  17. Allen’s Test • Both the ulnar and radial arteries are occluded. • Ask the patient to clench and unclench the fist until the hand is blanched. • Release pressure on the ulnar artery only and observe for color return to the hand.

  18. Allen’s Test • If colour returns within 5-7 seconds, the ulnar circulation is adequate. • Ulnar circulation is considered inadequate if the hand remains blanched for longer than 15 seconds. The radial artery should not be cannulated.

  19. Arterial Line Insertion And Sites • Insertion should be performed under sterile technique. • The connecting tubing should be assembled and flushed and the transducer zeroed and calibrated before the catheter is inserted. • Secured the catheter once it is in place.

  20. Normal Arterial Waveform A normal arterial waveform should has 3 components: • a rapid upstroke – systole • a clear dicrotic notch – closure of aortic valve • a definite end-diastole

  21. Pattern of different waveform

  22. Arterial pressure.. • Direct intra-arterial measurement may overestimate systolic pressure dt systolic overshoot • This is result of fluid-pressure transducer monitoring system • Can be overcome by ↑ damping of system ( ie by using smaller gauge cannula-transducer tubing)

  23. However, ↑ damping reduces the resonant frequency, thus the sensitivity of the sytem. • >30Hz  for HR up to 180bpm >20Hz for HR up to 120bpm • The tubing should be non-compliant & < 1 m in length

  24. Derived variables.. • Rough approx of SV, therefore CO can be obtained from area under systolic pressure curve • However, correlation with CO assessed by thermodilution is poor, & the method is not sufficiently reliable for clinical decision-making

  25. Systolic time intervals are an indirect index of ventricular contractility • Pre ejection period (PEP) = interval from ventricular electrical activity (Q wave)  ejection of blood from ventricle. • It consists of electromechanical delay btw the AP & initiation of ventricular contraction, and the isovolumetric contraction • PEP is inversely proportional to ventricular activity

  26. Adequacy of preload.. • The variation in arterial pressure is exaggerated in the presence of reduced preload • Significant correlation has been demonstrated between the systolic arterial pressure variation & end-diastolic area estimated with TOE.

  27. Complication • Ischaemia distal to cannula -major sequalaea/w low CO, shock, sepsis, prolonged cannulation, vasculitis & hyperlipidaemia • Exsanguination -flow thru 18G cannula can cause blood loss of 500ml/min • spurious result • Infection • Intra-arterial injection of drug

  28. The morbidity associated with arterial cannulation is less than that associated with 5 or more arterial punctures!!

  29. Nursing responsibilities • Prevention of blood loss • Prevention of local obstruction • prevention of air embolism • Prevention of sepsis • Accuracies

  30. Troubleshooting.. Damped Waveforms • Pressure bag inflated to 300 mmHg • Reposition extremity or patient • Verify appropriate scale • Flush or aspirate line • Check or replace module or cable

  31. Central Venous Pressure Monitoring • Directly reflects RA pressure • Indirectly reflects the preload of the right ventricle(RV) or RV end-diastolic pressure. • Determined by the interaction of venous tone, central venous volume (blood returning to the heart), and the pumping ability of the heart

  32. Central Venous Pressure • CVP is measured in the superior vena cava or the RA. • Normal ranges 4 – 12 cmH2O

  33. Common sites • Internal jugular vein • Subclavian vein • Brachial vein • Femoral vein

  34. Position • The head is placed in a dependent position (Trendelenburg), which causes the internal jugular vein to become more prominent, facilitating line placement.

  35. Catheter Placement • A long intravenous catheter is inserted into the large veins of the upper thorax (subclavian or internal jugular) are most frequently used for percutaneous CVP line insertion.

  36. Catheter Placement • Threaded into position in the vena cava close to the right atrium. • Correct placement confirmed by observing pressure change with respiration, aspirating blood freely thru catheter & CXR.

  37. Indication • Measurement of central venous pressure • Measurement of central venous oxygenation • Parenteral nutrition • Administration of vasoactive and inotropic agents • As a venous access when all IV sites have been exhausted

  38. CVP is used as guide to right ventricular filling • However, right ventricular preload is determined by EDV (not pressure) hence • Isolated CVP reading is of limited value without knowledge of ventricular compliance • Compliance varies from patient to patient, & with time in the same patient • Thus dynamic changes in CVP are more useful than absolute values.

More Related