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Cardiac Monitoring

Cardiac Monitoring. Presentation by Mr. Imran Khan Assistant Professor School of Nursing Science and research. Heart Rate monitoring. “Finger on pulse” is the easiest and quickest method to assess heart rate.

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Cardiac Monitoring

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  1. CardiacMonitoring Presentation by Mr. Imran Khan Assistant Professor School of Nursing Science and research

  2. Heart Ratemonitoring • “Finger on pulse” is the easiest and quickest method to assess heartrate. • ECG is most common method to detect heart rate in ot, by measurementof • r-r interval. • ECG can get confounded by electrosurgical instruments, power line noises, twitchings and fasciculations, lithotripsy machine, cardiopul bypass, and fluid warmers. • Direct ECG monitoring is better than monitoring of derived heartrate.

  3. Picture shows HR of 49 but direct observation shows dangerous bradyarrythmia it may be a asystole that cannot be assessed by digitally displayed HR. Arrow shows correction of baseline by ECGfilters.

  4. Pulse Ratemonitoring • Difference between pulse rate and heart rate is the difference between electrical depolarization and mechanical contraction ofheart. • Pulse deficit arises in conditions such as AF , PEA( in Cardiac tamponade, extreme hypovolemia, and conditions where electrical activity is present but not capable of producingpulse). • Pulse oxymetery gives PR. Although it seems redundant to measure both HR and PR but its important to avoiderror.

  5. Arteial blood pressuremonitoring • Sphygmomanometer use for systolic blood pressure first described by Riva and Rocci in 1896(palpatory method). Korotkoff in 1905 described measurement of diastolic as well.(auscultatorymethod). • Any condition causing decrease in blood flow below the level of detection,or • conditions needing excessive pressure to occludeartery. • Size of cuff 40% and 80%of circumference and length of arm. Too large can still be accepted but too small will give spuriously high reading. Pressure should be released slowly to assess korotkofs soundsproperly.Rapid deflation results in falsely lowreadings.

  6. Complications of Noninvasive Blood PressureMeasurement • Pain • Petechiae andecchymoses • Limb edema • Venous stasis andthrombophlebitis • Peripheralneuropathy • Compartmentsyndrome

  7. IBP/ Direct blood pressuremonitoring • Despite various complications and need of expertise IBP monitoring is ideal reference standard for BP monitoring ,which provide timely and crucial information. • Arterial cannulation can be done in radial, ulnar, brachial, axillary or femoralartery. • More central the artery is more are the chances of embolism. Axillary and femoral arterial cannulation results waveforms that resembles change in pressure in aortic arch moreclosely. • In radial artery cannulation hyperextension is avoided to prevent median nerve injury and in femoral artery cannulation must be done below the inguinalligament.

  8. MODIFIED ALLENSTEST odified Allen’sTest

  9. Indications for ArterialCannulation • Continuous, real-time blood pressure monitoring • Planned pharmacologic or mechanical cardiovascularmanipulation • Repeated bloodsampling • Failure of indirect arterial blood pressure measurement • Supplementary diagnostic information from • the arterialwaveform • Determination of volume responsiveness from systolic pressure or pulse pressure variation

  10. Complications of Direct Arterial Pressure Monitoring • Distal ischemia,pseudoaneurysm, • arteriovenous fistula. • Hemorrhage,hematoma • Arterialembolization • Local infection,sepsis • Peripheralneuropathy • Misinterpretation ofdata • Misuse ofequipment

  11. Central venous Pressuremonitoring • Central vein is catheterized for variouspurposes. • Measurement of CVP is often necessary in heamodynamically unstableand • patietns undergoing majorsurgeries. • Rt IJV is most commonly catheterised central vein. Others are left IJV , right and left subclavian, femoral, external jugulars andaxillary. • Most commonly used size is 7 French , 20 cm catheter with a 18 gintroducer • needle and guide wire.

  12. Indications for Central VenousCannulation • Central venous pressuremonitoring • Pulmonary artery catheterization andmonitoring • Transvenous cardiacpacing • Temporaryhemodialysis • Drug administration -Concentrated vasoactivedrugs • Hyperalimentation • Chemotherapy • Agents irritating to peripheralveins • Prolonged antibiotic therapy (e.g.,endocarditis) • Rapid infusion of fluids (via largecannulas) • Majorsurgery • Aspiration of airemboli • Inadequate peripheral intravenousaccess • Sampling site for repeated bloodtesting Trauma

  13. Complications ofCVP: • Mechanical Vascular injury Venous • Hemothorax Cardiactamponade • Respiratorycompromise • Airway compression from hematoma Tracheal, laryngeal injury Pneumothorax • Nerveinjury • Arrhythmias • Subcutaneous/mediastinalemphysema Arterial • Thromboembolic Venous thrombosis Pulmonary embolism • Arterial thrombosis and embolism (air,clot) • Catheter or guidewireembolism • Infectious Insertion siteinfection Catheterinfection • Bloodstreaminfection Endocarditis • Misinterpretation ofdata • Misuse ofequipment

  14. Technique: Aseptic precautionsundertaken Local infiltration done Check balloon integrity by inflating with 1.5ml ofair Check lumens patency by flushing with saline0.9% Cover catheter with sterile sleeveprovided Cannulate vein with Seldingertechnique Place sheath Pass catheter through sheath with tip curved towards theheart

  15. 9. Once tip of catheter passed through introducer sheathinflate balloon at level of rightventricle The progress of the catheter through right atrium and ventricle into pulmonary artery and wedge position can be monitored by changes in pressuretrace After acquiring wedge pressure deflate balloon

  16. ECHO/DOPPLER CARDIOGRAPHY • A diagnostic Study that reveals informationabout: • The structure and function of theheart • Cardiac hemodynamics of theheart

  17. THEORY AND TECHNIQUE OF THESTUDY • Utilizes the Application of Ultasonic waves being reflected back on hittinga • structure • This is done utilizing a transducer that both sends out the beam and then receives it back • The transducer can have one crystal or multiplecrystals • Utilizing the technique of doppler with ultrasound allows the ability to quantitate the direction and velocity ofobjects

  18. THIS TECHNIQUE ALLOWS THE EVALUATIONOF: • Cardiac Chambers- size and motion orfunction • The thickness of the walls of the heart • Abnormal Objects in the heart: tumors ormasses • Valvular structure (size andshape) • Valvular function (thickness, stenosis, orleakage) • Blood flow-hemodynamics • Other pathologies- fluid: pericardial effusionOther objects- vegetationsetc. • Mechanicalvalves • Pacemakerwires

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