Advanced Hemodynamics
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Everything you need to understand hemodynamic monitoring.
![DEFINITION PURPOSE DEFINITION HEMODYNAMIC MONITORING ,[object Object],[object Object]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Advanced Hemodynamics
- 1. Introduction to HEMODYNAMIC MONITORING
- 13. Stroke Volume Preload Afterload Contractility Filling Pressures & Volumes Resistance to Outflow Strength of Contraction CVP PAOP (PAD may be used to estimate PAOP) PVR, MPAP SVR, MAP RVSV LVSV Fluids, Volume Expanders Diuretics Vasoconstrictors Vasodilators Inotropic Medications
- 18. The PA Catheter
- 20. The Pulmonary Artery Catheter
- 22. BREAK Take 5 MINUTES
- 23. Demonstration of PA catheter and Hands-on practice
- 31. Phlebostatic Axis 4th ICS Mid-chest, regardless of head elevation
- 32. Phlebostatic Axis 4th ICS Mid-chest, regardless of head elevation
- 42. Right Atrium (CVP) Normal Value 0-8 mmHg RAP = CVP Wave Fluctuations Due To Contractions
- 45. Absent A Wave *PACEP.ORG 2007 * Measure at end of QRS!
- 48. CVP Waveform Analysis Normal CVP Waveform
- 49. Reading the RA CVP) Waveform
- 50. CVP Waveform Vented Patient
- 51. CVP Waveform Vented Patient – “Vent Valley” a wave
- 52. CVP Waveform Analysis Artifact in Waveform
- 53. Right Ventricle Normal Value 15-25/0-8 mmHg Catheter In RV May Cause Ectopy Swan Tip May Drift From PA to RV
- 54. RV Waveform
- 56. Reading the RV Waveform
- 58. Pulmonary Artery Normal Value 15-25/8-15 mmHg Dicrotic Notch Represents PV Closure PAD Approximates PAWP (LVEDP) (in absence of lung or MV disease)
- 59. PA Waveform
- 62. Reading the PA Waveform Dicrotic notch
- 63. PA Waveform Identify that it is the PA tracing Look at the scale What is the PAP? 10/20/30
- 64. PA Waveform Look for dichrotic notch Look at scale What is the PAP?
- 65. PAOP / Wedge Normal Value 8-12 mmHg Balloon Floats and Wedges in Pulmonary Artery PAWP = LAP = LVEDP Wedging Can Cause Capillary Rupture
- 69. Wedging Can Cause Pulmonary Artery Rupture
- 70. PA Tracing to PAOP Tracing to PA Tracing
- 74. Cardiac Output via Thermodilution *PACEP.ORG 2007
- 75. Averaging CO Measurements *PACEP.ORG 2007
- 77. Mixed Venous Oxygen Saturation
- 82. SvO2 Application In a case of increased SVR with decreased CO. Nitroprusside was started. The increase in SvO 2 and increase in CO reflects the appropriateness of therapy.
- 87. Removal of the PA Catheter
- 90. Break Take 5 Minutes
- 92. MEASUREMENTS
- 100. SAMPLE MEASUREMENTS
- 101. SAMPLE MEASUREMENTS
- 102. SAMPLE MEASUREMENTS
- 103. SAMPLE MEASUREMENTS
- 104. SAMPLE MEASUREMENTS
- 105. SAMPLE MEASUREMENTS
- 106. SAMPLE MEASUREMENTS
- 107. Review
- 114. Questions?
Editor's Notes
- Changes in CO and SV!
- The CO and the SVR will modulate to maintain blood pressure even if CO is very low. Because of this phenomenon, the BP is not a good measure of cardiac output
- The pulse pressure tells you more about afterload than the BP does
- The Cordis Offers A Large Bore Infusion Port There Are Ten Types Of Swan-Ganz Catheters VIP Catheter Has Three Other Infusion Ports Large Markers = 50cm, Small Markers = 10cm Components: 1. Proximal port – approximately 30 cm from tip of catheter. Also known as the CVP port (central venous pressure). It lies in the right atrium and measures CVP. It can be used for infusion of IV solutions or medications, for drawing blood and for injecting cardiac output boluses. It is usually color coded blue. 2. Distal port – opening is at the tip (end) of the catheter. A lso known as the PA port. It lies directly in the pulmonary artery and measures the pulmonary artery pressures (PAP), systolic (PAS), and diastolic (PAD). It also measures the pulmonary capillary wedge pressure (PCWP) when the balloon is inflated. The PA pressures should always be monitored continuously . NEVER USE the PA port for medication infusion. It c an be used for drawing &quot;mixed venous&quot; blood gas samples. It is u sually color coded yellow. 3. Thermistor and connector port T he thermistor connector connects the pulmonary catheter to the cardiac output computer. The connector is at the end of a separate catheter lumen outside the patient thermistor wire. Blood temperature is transmitted within the lumen (the core temperature is the most accurate reflection of the body temperature). It is used in determining cardiac output. The connector tip should always have a protective covering to protect patient from microshock. It is usually color coded yellow with a red connector. 4. Balloon port The balloon port is located < 1 cm from the tip of the catheter. When the balloon is inflated with approximately 0.8 to 1.5 cc of air, the catheter will become lodged (wedged) in the pulmonary artery and gives a wedge tracing. It r eflects the pressures that are in the left side of the heart when inflated. DO NOT INFLATE WITH LIQUID---- ALWAYS INFLATE WITH AIR. When deflated, turn stopcock to off position and leave syringe connect to the port. It is usually color coded red. 5. A 5 - lumen Swan Ganz catheter has either an infusion port or a pacing port A pacing port allows for insertion of a transvenous pacing wire. The infusion port allows for infusion of IV solutions or medications. It is usually color coded white.
- EQUIPMENT NECESSARY FOR INSERTION Flush solution for transducer system Flush solution for cardiac output system Arterial access line Disposable triple pressure transducer system Pulmonary artery catheter Monitor, module, electrodes, cables Central line kit Transducer holder, I.V. pole, pressure bag Emergency resuscitation equipment Prepackaged Introducer Kit; sutures Sterile gowns, gloves, and masks
- Correct the students about the location of the phlebostatic axis
- 1) Normal Pressures: RA = 1-7 RV = 15-25/1-7 PA = 15-25/8-15 PAD = 8-15 PAWP = 6-12
- It is essential that you be able to recognize the RV waveform – If the tip migrates to the RV during monitorin it can cause dysrhythmias. The proper intervention is to have an MD or qualified PA/CRNA advance the catheter or you can pull the tip back to the RA. Check your unit’s protocols.
- Action taken will depend on unit protocols and availability of an MD or advanced practitioner to reposition the catheter. Know your unit’s protocols before you do anything
- Looks like a CVP waveform, but the timing is different
- Looks like a CVP waveform – just occurs later
- CVP Example
- CVP Answer
- Example 1
- Answer 1
- Example 2
- Answer 2
- Example 3
- Answer 3
- Example 4
- Answer 4
- Example 5
- Answer 5
- Example 6
- Answer 6