1 / 35

Hemodynamic Monitoring Part I (ABP, CVP, Ao)

Learn about hemodynamic monitoring techniques including arterial blood pressure (ABP), central venous pressure (CVP), and continuous airway pressure (Ao). Understand the importance of proper cuff fitting, leveling and zeroing, potential complications, troubleshooting, and more.

gking
Download Presentation

Hemodynamic Monitoring Part I (ABP, CVP, Ao)

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. Hemodynamic MonitoringPart I(ABP, CVP, Ao) MICU Competencies 2006-2007

  2. What is Hemodynamic Monitoring? • Non-invasive = clinical assessment & NBP • Direct measurement of arterial pressure • Invasive hemodynamic monitoring

  3. Noninvasive BP Heart Rate, pulses Mental Status Mottling (absent) Skin Temperature Capillary Refill Urine Output Noninvasive Hemodynamic Monitoring

  4. Proper Fit of a Blood Pressure Cuff • Width of bladder = 2/3 of upper arm • Length of bladder encircles 80% arm • Lower edge of cuff approximately 2.5 cm above the antecubital space

  5. Why A Properly Fitting Cuff? • Too small causes false-high reading • Too LARGE causes false-low reading

  6. Indications for Arterial Blood Pressure • Frequent titration of vasoactive drips • Unstable blood pressures • Frequent ABGs or labs • Unable to obtain Non-invasive BP

  7. Arterial Catheter Pressure Tubing Pressure Cable Pressure Bag Flush – 500cc NS Supplies to Gather

  8. Sterile Gown (2) Sterile Towels (3) Sterile Gloves Suture (silk 2.0) Chlorhexidine Swabs Mask Supplies to Gather

  9. Leveling and Zeroing • Leveling • Before/after insertion • If patient, bed or transducer move • Zeroing • Performed before insertion & readings • Level and zero at the insertion site

  10. Potential Complications Associated With Arterial Lines • Hemorrhage • Air Emboli • Infection • Altered Skin Integrity • Impaired Circulation

  11. Documentation • Insertion procedure note • ABP readings as ordered • Neurovascular checks every two hours (in musculoskeletal assessment of HED) • Pressure line flush amounts (3ml/hr) • Tubing and dressing changes

  12. Central Venous Pressure Assesses . . . • Intravascular volume status • Right ventricular function • Patient response to drugs &/or fluids

  13. Central Venous Pressure (CVP) • Central line or pulmonary artery catheter • Normal values = 2 – 8 mm Hg • Low CVP = hypovolemia or ↓ venous return • High CVP = over hydration, ↑ venous return, or right-sided heart failure

  14. Leveling and Zeroing • Leveling • Before/after insertion • After patient, bed or transducer move • Aligns transducer with catheter tip • Zeroing • Performed before insertion & readings • Level and zero transducer at the phlebostatic axis

  15. Phlebostatic Axis • 4th intercostal space, mid-axillary line • Level of the atria (Edwards Lifesciences, n.d.)

  16. More on Leveling and Zeroing • HOB 0 – 60 degrees • No lateral positioning • Phlebostatic axis with any position (dotted line) (Edwards Lifesciences, n.d.)

  17. Dynamic Flush • Dynamic flush ensures the integrity of the pressure tubing system. Notice how it ascends - forms a square pattern - and bounces below the baseline before returning to the original waveform. • Check dynamic flush after zeroing any pressure tubing system

  18. System Maintenance • Change tubing and fluid bag q 96hrs • No pressors through CVP port • Antibiotics, NS boluses, blood, & IV pushes are allowed through the CVP line

  19. Troubleshooting • Improper set-up and equipment malfunction are the primary causes for hemodynamic monitoring problems • Retracing the set-up process or tubing (patient to monitor) may identify the problem and solution quickly • Use your staff resources: Help All, Charge Nurse, Educator, Preceptors, MICU experts

  20. 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

  21. Troubleshooting Inability to obtain/zero waveform • Connections between cable & monitor • Position of stopcocks • Retry zeroing after above adjustments

  22. Continuous Airway Pressure (Ao) • Also known as Paw, Ao • Purpose: • Improves accuracy of hemodynamic waveform measurements • Identification of end-expiration • Positive waveform deflections = positive pressure ventilation • Negative deflections = spontaneous inspiratory effort

  23. Supplies to Gather • Pressure Cable • Pressure Tubing • Connector (Edwards Lifesciences, n.d.)

  24. Setting up the Ao • Discard infusion spike end & cap port • Connect pressure tubing to vent tubing (using connector opposite heating cable) • Connect cables • Zero the tubing (leveling not necessary)

  25. Troubleshooting Ao • Do not prime tubing with fluids! • Damping will occur with fluid or secretions • To evacuate any fluids, disconnect pressure tubing from vent tubing and push air through the pressure tubing with a 10 ml syringe connected at one end until fluid-free

  26. 15 10 5 0 -5 CVP=13 Pressure Measurement 1) Record Ao and CVP on the same strip 2) Find end-expiration by drawing a vertical line with a straight edge 200 ms prior to the rise or dip in Ao (1 large box) associated with a breath. 3) Draw a horizontal line through the visually assessed average vascular pressure starting at end-expiration going backward 200 ms (1 large box). 4) Read the pressure at the horizontal line.

  27. Assist-Control 200 ms { Ao { CVP 200 ms

  28. CPAP with Pressure Support 200 ms { Ao { 200 ms CVP

  29. CPAP without Pressure Support 200 ms { Ao { 200 ms CVP

  30. Incorrect method! This point was identified as end-expiration for a pt. who did not have an Ao set up. 40 30 20 10 0 -10 Correct method! 30 sec after the above tracing, Ao was added & true end-expiration clearly identified.

  31. 40 30 20 10 0 -10 40 30 20 10 0 -10 Same patient 20 minutes later

  32. 15 10 5 0 -5 CVP=13

  33. Summary • Record Ao with CVP • Read mean CVP at end-expiration as described. No need read vascular pressure at any particular time in the cardiac cycle

  34. Documentation of CVP • Include on waveform strip • Position of the HOB • Vasopressors and rates • Amount of PEEP • Scale • CVP measurement • Signature of the nurse (post in green chart behind graphics tab)

  35. References & Resources Burns, S. M. (2004). Continuous airway pressure monitoring. Critical Care Nurse, 24(6), 70-74. Chulay, M., & Burns, S. M. (2006). AACN Essentials of critical care. McGraw-Hill: New York. Edwards. (2006). Pulmonary Artery Catheter Educational Project. http://www.pacep.org Edwards Lifesciences. (n.d.) Educational videos. www.edwards.com MICU Routine Practice Guidelines. www.vanderbiltmicu.com MICU Bedside Resource Books MICU Education Kits (Red cart in conference room) MICU Preceptors, Help All Nurses, & Charge Nurses VUMC policies. http://vumcpolicies.mc.vanderbilt.edu

More Related