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Hemodynamic Measurements

Thomas
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Hemodynamic Measurements

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    1. Hemodynamic Measurements

    3. Blood Pressure

    4. Arterial Blood Pressure Measurement (Riva-Rocci Method)

    5. Arterial Blood Pressure Measurement (Riva-Rocci Method)

    6. Arterial Blood Pressure Measurement (Riva-Rocci Method)

    7. Riva Rocci Blood Pressure Measurement Methods Auscultation Return-to-flow Techniques Palpation Pulse oximeter (Plethysmographic Waveform) Indwelling arterial catheter

    8. Automated Blood Pressure Cuff

    9. Arterial Catheter Insertion Points Radial Artery Brachial Artery Femoral Artery Dorsalis Pedis Artery Axillary Artery Ulnar Artery

    10. Arterial Blood Pressure Tracing

    11. The pressure curves change in arteries at different distances from the heart

    12. Changes in Arterial Pressure during Mechanical Ventilation

    13. Assessing Natural Frequency and Damping in Arterial Line System

    14. Assessing Natural Frequency and Damping in Arterial Line System

    15. Dynamic Response

    16. Natural frequency of the monitoring system System requirements Use wide-bore, high-pressure tubing no longer than 122 cm (48 in) Avoid tubing extensions and minimize stopcocks Ensure that all connections are tightened Eliminate air from the flush fluid and air bubbles from the tubing system Keep continuous flush bag filled and keep external pressure cuff at 300 mm Hg pressure Clear access catheter and tubing system of any fluid other than isotonic sodium chloride solution

    17. Central Venous Pressure

    18. Central Venous Pressure Strictly speaking, CVP is the pressure at the junction of the vena cavae and the right atrium Normal range in a spontaneously breathing patient is 1 to 7 mm Hg CVP reflects the driving force for filling the right atrium and ventricle

    19. CVP Waveforms

    20. Swan-Ganz Catheter Pulmonary Artery Catheter

    21. Swan-Ganz Catheter (Pulmonary Artery Catheter)

    22. Pulmonary Artery Catheterization “Pulmonary artery catheterization has evoked more controversy than any other widely adopted cardiovascular monitoring practice because it is an expensive, invasive technique that is widely used but still not rigorously proven to improve patient outcome.” Jonathan B. Mark and Thomas F. Slaughter Miller Anesthesia, 6th Edition.

    23. Waveforms During Swan-Ganz Catheter Insertion

    24. Swan-Ganz Catheter Assumption:

    25. Pulmonary Artery Catheter Indications PAC monitoring is considered to be appropriate or necessary, or both, in selected surgical patients undergoing procedures with a high risk of complications form hemodynamic changes (e.g. cardiac surgery). Or in those with advanced cardiopulmonary diseases who would be at increased risk for adverse perioperative events because of their preoperative medical condition.

    26. “Zeroing” Transducers

    27. “Zeroing” Transducers Two distinct steps: Establishing a standard reference value, ambient atmospheric pressure, which is assigned the value of 0 mm Hg and used as the reference point for all subsequent intravascular pressure measurements. The second step in transducer setup involves placing the transducer at the appropriate vertical height relative to the patient’s position.

    28. Appropriate Vertical Height of Transducer Relative to the Patient’s Position Align external pressure transducers with the uppermost blood level in the chamber from which pressure is being measured. Based on echocardiographic data, the best transducer placement for standard clinical monitoring is at a vertical height approximately 5 cm below the left sternal border at the fourth intercostal space. References: Mark, JB: Interpretation of Hemodynamic Monitoring, IARS 2003 Review Course Lectures, pp. 56-59. Courtois, M et al: Anatomically and physiologically based reference level for measurement of intracardiac pressures. Circulation 1995 (92): 1994-2000.

    29. Cardiac Output

    30. Cardiac Output CO = HR x SV SV = EDV – ESV

    31. Cardiac Output: Fick Measurement

    33. Cardiac Output Thermodilution Technique Based on the indicator dilution technique and utilizes temperature as the indicator A known amount of indicator (saline) at a known temperature (lower than blood) is injected into the right atrium This indicator mixes with blood lowering its temperature The temperature is measured near the tip of the catheter; the change over time expressed as the area under the curve is planimetered to calculate the cardiac output

    34. Stewart-Hamilton Equation Vi (Tb - Ti) x K

    35. Cardiac Output: Thermodilution

    39. Other Methods of Cardiac Output Measurement Ultrasound-Based Methods Esophageal Doppler Bioimpedance Partial CO2 Rebreathing Fick Method Lithium Dilution Pulse Contour Cardiac Output Monitoring

    40. THE END

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