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HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)

HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c). Equipment Needed for Hemodynamic Monitoring Transducer: an instrument that senses physiological events & transforms them into electrical signs

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HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)

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  1. HEMODYNAMIC MONITORING NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN PhD (c)

  2. Equipment Needed for Hemodynamic Monitoring • Transducer: an instrument that senses physiological events & transforms them into electrical signs • Amplifier: connects to transducer and an electrical cable;filters out interference so signal can be displayed • Monitors: provides display of original signal • Catheter, tubing flush system (single or double): pressure bag is 500cc Normal Saline with 10cc of 100u/ml of heparin; delivers continuous cc/hr to keep line open; catheter may be arterial or venous

  3. Monitoring Hemodynamic Measurements • Arterial – used for unstable BP or frequent ABG’s or labs • Controversial regarding accuracy • Inserted by MD, RT, or Anesthesia • Inserted into any artery • Waveform: peak represents SBP and Ventricular contraction, lowest point reflects peripheral resistance & diacrotic notch is on the downward stroke & results from aortic valve closure • MAP – mean arterial pressure represents perfusion pressure in aorta and branches; SBP-DBP/3 + DBP = MAP • Nursing considerations • Complications

  4. Central Venous Pressure – represents blood return to the heart; abnormalities usually secondary to altered venous tone and / or blood volume • Inserted by MD under sterile conditions • Normal value is 0-8 mm Hg • Increase in blood volume = increase in CVP (vice versa) • Triple Lumen Catheter (TLC); distal port on TCL and proximal on Swan Ganz catheter • Measured at end of expiration: ventilated patients lowest part of waveform and vice versa for spontaneous breathing

  5. Pulmonary Artery Catheter or Swan Ganz Catheter – allows monitoring of Left Ventricular function • Various ports – proximal (cardiac output), distal (PA), balloon (wedge or PCWP), RV (pacer port) & temp (core blood temp) • Inserted by MD under sterile conditions at the brachial, subclavian, internal jugular or external jugular veins • All measurements done at end of expiration

  6. What can we monitor with the Swan Ganz Catheter? • PAP – pulmonary artery pressure; @ 25/10 with average 15 • PCWP – pulmonary catheter wedge pressure; @ 6-12; use of DPAP if balloon not working • Cardiac Output – can be measured intermittently or continuously • -- injectate is D5W or NS @ 10cc • --errors in CO • -- 3 values averaged (within 10%) of each other • -- CO = 4-8 L/min • -- CI or cardiac index = CO/BSA usually greater than 2

  7. Mixed Venous Oxygenation (SVO2) – allows clinician to look at overall picture of O2 used by the body organs • CVP – central venous pressure 0-8mmHg • SVR – systemic vascular resistance- measures the opposition to blood flow exerted by blood vessels; 800-1200 normal value • Formula: SVR= MAP-CVP x 80/ CO • PVR – pulmonary vascular resistance • Formula: PVR= MAP-PCWP x 80/CO

  8. Volume Effects on Hemodynamic Monitoring • What is the difference between intracellular and extracellular volume? • Arterial Pressure • Central Venous Pressure • PAP/PCWP • Cardiac Output • SVR

  9. Pharmacological Agents Used in Hemodynamic Monitoring • Arterial Pressure • Dopamine > or= 5 mcg/kg/min up to 20mcg/kg • Epinephrine mcg/min • Neosenephrine mcg/min • Levophed or norepinephrine mcg/min • CVP • Volume controlled • PCWP/PAP –increase CO by decreasing PAP and PCWP • Dobutamine 5-20 mcg/kg/min • Natrecor .001mcg/kg/min

  10. Cardiac Output • Dobutamine and Natrecor • Must be sure enough volume on board to gain desired effect • SVR • Nipride mcg/kg/min used to decrease SVR and increase CO • Cardene 5-10mg/hr

  11. Inotropic Agent Calculations • Difference between positive and negative inotropic drugs? • Dosing charts: CONCENTRATION of drug must match in order to use charts • Pharmacy directions for drug adminstration: always DOUBLE-CHECK! • Fudge Factors: a way of calculating dosages and rates

  12. Fudge Factors • Know the concentration of drug ordered • Know the patient’s weight in kilograms • Know the volume of dilution • Know correct dosage administration for drug ordered • Remember constants

  13. Fudge Factor Formula • How is the drug run? mcg/min, mcg/kg/min, mcg/kg/hour, mg/min • Fill in the necessary formula components mg x 1000mg x 1000 volume x kg x 60 volume x 60 mg x 1000 mg volume x kg volume x 60

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