Nursing management of Hemodynamic Monitoring – Flashcards
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Right ventricular pressure
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RVP Normal systolic- 20-30mmHg diastolic 0-5mmHg
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pulmonary artery pressure
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normal range systolic 20-30mmHg diastolic 10-20mmHg
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pulmonary artery wedge pressure
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normal range mean: 4-12mmHg
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Cardiac output
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volume of blood ejected from the heart per minute
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CO=
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HR x stroke volume (volume of blood ejected with each beat) 4-8L/min
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ejection fractions
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fraction of blood ejected with each beat Normal: 60-70%
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Preload
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degree of muscle fibers stretch before systole Volume of blood in ventricle prior to contractions (LVEDP)
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frank-starlin law
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increased stretch = increased volume stretch is within the physiological limits example = balloon
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Afterload
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resistance left ventricle must overcome to circulate blood, increased in hypertension and vasoconstriction (inc. afterload = inc. cardiac workload
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preload
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volume of blood in ventricles at the end of diastole (end diastolic pressure) increase in hypervolemia, regurgitation of cardiac valves, heart failure.
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afterload
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pressure of resistance against flow, related to lumen size and viscosity, Hct reading dec. in beta blocker to skeletal muscle arterioles
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systemic vascular resistance
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force overcome by the left ventricle upon contraction
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pulmonary vascular resistance
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force overcome by the right ventricle upon contraction
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contractility
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force of ventricular contraction, how well the heart is pumping intracellular K, Mg, Ca can affect contractility
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systemic vascular resistance.
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peripheral vascular, diameter of blood vessels arterial BP = CO x SVR normal SVR is 800-1200 Dynes/SEC/CM2
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Cardiac output versus index
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index is a better assessment, based on body size CI= CO / body surface area calculated on the computer after entering patient's height and weight. 2.2-4.8 L/min/m2- normal cardiac index.
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noninvasive modalities:
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noninvasive BP, assessment of JVP, assessment of serum lactate levels .5-1MMol/L less than 2.0mmol/L in critical illness
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invasive modalities
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artierial pressure monitoring pulmonary artery pressure monitoring right atrial pressure monitoring
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components of invasive hemodynamic monitoring
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invasive catheter, noncompliant pressure tubing, transducer and stopcocks, flush system, bedside monitor, system must be leveled and zeroed for accuracy.
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radial artery
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radial artery: allen's test prior to insertion to verify collateral circulation in the extremity, issues related to predictability of Allen's test -brachial, femoral
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pressurized bag
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keep blood in body, must be held above patient
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arterial pressure monitoring
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waveforms can dampen or flatten out if the catheter is kinked or up against the arterial wall.
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complications
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thrombosis- clot if flush not used appropriately embolism- air entering system/clot dislodgment hemorrhage- loose connections/ catheter dislodgment infection
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RAP/CVP monitoring
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right atrial pressure- catheter in right atrium proximal port of pulmonary artery catheter
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central venous pressure (CVP)
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catheter in superior or inferior vena cava triple lumen, picc line
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normal value of CVP
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2-6mmHg
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RAP/CVP
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zero/balance, waveform analysis, respiratory variation and PEEP patient position: head of bed between zero and sixty degrees correlate values with assessment monitor for complications
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complications of RAP/CVP
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infection, pneumothorax or hemothorax, carotid puncture, heart perforation, dysrhythmias
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Pulmonary artery pressure monitoring
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pulmonary artery catheter (PAC) introduced in 1970 swap-ganz reflects left ventricular function
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pulmonary artery catheter
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flow directed catheter, inserted via subclavian, internal jugular, or femoral vein, balloon tip, mutiple lumens
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insertion of a PA catheter
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proper position of patient (trendelenburg common, towel roll between shoulder blades) -inserted with a balloon deflated, selected inflation to "float" catheter into PA waveform changes as catheter progresses -check for proper wedging for pulmonary capillary wedge pressure (PCWP) or also called pulmonary artery occlusion pressure (PAOP)- measures preload -chest x-ray
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PAP
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15-30mmHg / 4-12Hg
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PCWP
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pulmonary capillary wedge pressure pressure measured by wedging a pulmonary catheter with an inflated balloon into a small pulmonary arterial branch 5-15mmHg
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PAOP/PCWP/PAWP
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inflated balloon flows into wedge position in pulmonary capillary measuring pressure
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measure pulmonary artery pressure
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reflects left ventricular end-diastolic pressure no more than 1.5mL to fill balloon
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continuous fiberoptic central venous oximetry monitoring
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relationship between o2 demand and o2 consumption in the body normal is 65-85% decreased- insufficient 02 to meet metabolic demands -low 02 delivery, increased o2 consumption
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complications of PA catheters
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infections, dysrhythmias, air embolus, thromboembolism, PA rupture, pulmonary infarction
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in cardiogenic shock, expected for
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dec. CO, in PAOP
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cardiac output monitoring
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thermodilution cardiac output (TDCO)
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procedure
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injection solution within four sec. -inc. accuracy at end expiration -check waveform -repeat at least 3 measurements -average values within 10% of each other -calculate Co and cardiac index (computer does this)
