Hemodynamic Monitoring-ATI – Flashcards

involves special indwelling catheters to provide information about blood volume and perfusion, fluid status, and how well the heart is pumping

-Central venous pressure (CVP) -Pulmonary artery pressure (PAP) -Pulmonary artery wedge pressure (PAWP) -Cardiac Output (CO) -Intra-arterial pressure

indicates the balance between oxygen supply and demand. It is measured by a pulmonary artery catheter with fiberoptics.

is comprised of a catheter with an infusion system, a transducer, and a monitor is used to display a client's hemodynamic information.

Hemodynamic pressure lines must be calibrated to read atmospheric pressure as 0 and the transducer should be positioned at the RA (phlebostatic axis)

-Pressure transducer -Pressure tubing -Monitor -Pressure bag and flush device

In the radial (most common), brachial, or femoral artery

-Arterial lines provide continuous information about changes in blood pressure and permit the withdrawal of samples of arterial blood. Intra-arterial pressures may differ from cuff pressures. -The integrity of the arterial waveform should be assessed to verify the accuracy of BP readings. -Arterial lines are not to be used for IV fluid infusion.

Monitor circulation in the limb with the arterial line (capillary refill, temperature, color).

Pulmonary artery (PA) catheters have multiple ports and components that enable a variety of hemodynamic measurements, the collection of blood samples, and the infusion of IV fluids.

The PA catheter is inserted into a large vein (internal jugular, femoral, subclavian, brachial) and threaded through the right atria and ventricle into a branch of the pulmonary artery

-Proximal lumen -Distal lumen -Balloon inflation port -Thermistor -Additional infusion ports, depending on the brand.

can be used to measure right atrial pressure (CVP), infuse IV fluids, and to obtain venous blood samples.

can be used to measure pulmonary artery pressures (PA systolic, PA diastolic, mean pulmonary artery pressure, and pulmonary artery wedge pressure.) This lumen is not to be used for IV fluid infusion.

is intermittently used for PAWP measurements. When not in use, it should be left deflated and in the 'locked' position.

measures temperature differences between the right atrium and the pulmonary artery in order to determine cardiac output

-Serious or critical illness -Congestive heart failure -Post CABG clients -ARDS -Acute renal failure -Burn victims -Trauma victims

-Obtain informed consent -Gather equipment and supplies -Assemble pressure monitoring system. Purge all air from system. -Maintain sterility of connections. -Place client in supine or Trandelenburg position. -Monitor client status during and after the procedure (VS, SaO2, heart rhythm). -Administer sedation and pain meds. as prescribed. -Obtain chest x-ray following the procedure to confirm catheter placement. -Level transducer with phlebostatic axis (4th intercostal space, mid-axillary line). -Zero system with atmospheric pressure. -Obtain initial readings as prescribed. Compare arterial blood pressure to non-invasive cuff pressure (NIBP). -Document the client's response.

Monitor Symptoms of altered hemodynamics -Continually monitor respiratory and cardiac status (VSs, heart rhythm, SaO2). *Observe respiratory pattern and effort. *Compare NIBP to arterial blood pressure.

-Observe and document waveforms. Report changes in waveforms to the provider as this may indicate catheter migration or displacement. -Document catheter placement each shift and as needed (for example, after movement or transport). -Monitor and secure connections between pressure tubing, transducers, and catheter ports.

-Place the client in supine position prior to recording hemodynamic values. HOB may be elevated 15-30 degrees. -Level the transducer at the phelbostatic axis before readings and with all position changes -Zero system to atmospheric pressure. -Compare hemodynamic findings to physical assessment. -Monitor trends in values obtained over time. -Change flushing solution and tubing according to institution policy. -Flush pressure lines after blood samples to maintain line patency.

-Change dressing per hospital protocol and as needed. -Use surgical aseptic technique with all dressing changes (mask, sterile gloves, maintain sterile field). -Observe catheter site for swelling, redness, or drainage. -Practice thorough handwashing.

-Monitor the insertion site. -Monitor for evidence of infection (elevated WBC count, increased temperature). -Perform thorough handwashing. -Collect specimens (blood cultures, catheter tip cultures) and deliver to the lab. -Administer antibiotic therapy as prescribed. -Administer IV fluids for intravascular support. -Administer vasopressors (for example, dopamine) for vasodilation secondary to sepsis.

-Use heparinized solution for flushing system to prevent thromboemboism -Avoid introduction of air into flushing system to prevent air embolism. -There is a risk of pneumothorax with insertion of the line. -There is a risk of dysrhythmias with insertion/movement of the line.

The intravascular volume in older adult clients is often reduced; therefore, the nurse should anticipate lower hemodynamic readings, particularly if dehydration is a complication.