Hemodynamic Monitoring
prepared and presented by:
Mohammed Fouad El Deek
RN, MHS
Objectives of Hemodynamic Monitoring
Evaluate cardiovascular system
Pressure, flow, resistance
Establish baseline values and
evaluate trends
Determine presence and degree of
dysfunction
Implement and guide
interventions early to prevent
problems
Outlines
• Objectives .
• Definition of hemodynamic monitoring.
• Baseline and components of
Hemodynamic Monitoring.
• Arterial pressure Monitoring.
• Pulmonary Artery Pressure Monitoring.
• Pulmonary Artery Catheters.
• Hemodynamic normal Values.
• Summary.
What is Hemodynamic
Monitoring?
It is measuring the pressures in the
heart
Hemodynamic Monitoring
• Baseline data obtained (low cardiac
output)
• General appearance
• Level of consciousness
• Skin color/temperature
• Vital signs
• Peripheral pulses
• Urine output
Hemodynamic Monitoring
• Baseline data correlated with data
obtained from technology
(e.g., ECG; arterial, CVP, PA, and PAWP
pressures
**Single hemodynamic values are rarely
significant. Look at trends!!
Hemodynamic Monitoring
Components
Heart Rate
Blood Pressure and MAP
CVP
Pulmonary Artery Pressures
Systemic Vascular Pressure (SVR)
Pulmonary Vascular Pressure (PVR)
Cardiac Output/ Cardiac Index
Stroke Volume
Comparing Hemodynamics to IV pump
• Fluid =preload
• Pump= CO or
contractility (needs
electricity)
• Tubing =afterload
Types of Invasive Pressure
Monitoring
• Continuous arterial pressure monitoring
• Acute hypertension/hypotension
• Respiratory failure
• Shock
• Neurologic shock
• Coronary interventional procedures
• Continuous infusion of vasoactive drugs
• Frequent ABG sampling
Components of an Arterial
Pressure Monitoring System
Fig. 66-3
Arterial Pressure Monitoring
• High- and low-pressure alarms based on
patient’s status
• Risks
• Hemorrhage, infection, thrombus
formation, neurovascular impairment,
loss of limb (Assess 5 P’s)
Arterial Pressure Tracing
Fig. 66-6
Dicrotic notch signifies the closure of the
aortic valve.
Pulmonary Artery Pressure
Monitoring
• Guides management of patients with
complicated cardiac, pulmonary, and
intravascular volume problems
• PA diastolic (PAD) pressure and
PAWP: Indicators of cardiac function
and fluid volume status
• Monitoring PA pressures allows for
therapeutic manipulation of preload
Pulmonary Artery Pressure
Monitoring
• PA flow-directed catheter
• Distal lumen port in PA
• Samples mixed venous blood
• Thermistor lumen port near
distal tip
• Monitors core temperature
• Thermodilution method measuring CO
Pulmonary Artery Pressure
Monitoring
• Proximal -Right atrium port
Measurement of CVP
Injection of fluid for CO
measurement
Blood sampling
Administer medications
Pulmonary Artery Catheter
Fig. 66-7
PA Waveforms during Insertion
Fig. 66-9
Hemodynamics:
Normal value
Mean Arterial Pressure (MAP) 70 -90 mm Hg
Cardiac Index (CI)- 2.2-4.0 L/min/m2
Cardiac Output (CO)- 4-8 L/min
Central Venous Pressure (CVP) (also known as Right Atrial Pressure
(RA)) 2-8 mmHg
Pulmonary Artery Pressure (PA)
Systolic 20-30 mmHg (PAS)
Diastolic 4-12 mmHg (PAD)
Mean 15-25 mmHg
Pulmonary Capillary Wedge Pressure (PWCP)
6-12 mmHg
Systemic Vascular Resistance(SVR) 800-1200
Measuring Cardiac Output
• SVR, SVRI, SV, and SVI can calculated
when CO is measured
• ↑ SVR
• Vasoconstriction from shock
• Hypertension
• ↑ Release or administration of
epinephrine or other vasoactive
inotropes
• Left ventricular failure
Best indicator of tissue perfusion. Needs to be at
least 60 to perfuse organs
Complications with PA Catheters
• Infection and sepsis
• Asepsis for insertion and maintenance
of catheter and tubing mandatory
• Change flush bag, pressure tubing,
transducer, and stopcock every 96
hours
• Air embolus (e.g., disconnection)
Complications with PA Catheters
• Ventricular dysrhythmias
• During PA catheter insertion or removal
• If tip migrates back from PA to right
ventricle
• PA catheter cannot be wedged
• May need repositioning
Complications with PA Catheters
• Pulmonary infarction or PA rupture
• Balloon rupture (e.g., overinflation)
• Prolonged inflation
• Spontaneous wedging
• Thrombus/embolus formation
Noninvasive Hemodynamic Monitoring:
Impedance Cardiography (ICG)
• 4 dual sensors with 8 lead wires
placed on neck and chest
• Current transmitted by outer
electrodes and seeks path of
least resistance: blood filled aorta
• Baseline impedance (resistance)
is measured using inner
electrodes
• With each heartbeat, blood
volume and velocity in the aorta
change
• Corresponding change in
impedance is measured
• Baseline and changes in
impedance are used to measure
and calculate hemodynamic
parameters
Continuous or intermittent,
Continuous or intermittent, noninvasive method
noninvasive method
Continuous or intermittent, of obtaining
noninvasive method CO
andofstatus
obtaining CO and assessing thoracic fluid
assessing thoracic fluid status
of obtaining CO and assessing thoracic fluid
status
Noninvasive Hemodynamic
Monitoring
• Major indications
• Early signs and symptoms of
pulmonary or cardiac dysfunction
• Differentiation of cardiac or pulmonary
cause of shortness of breath
• Evaluation of etiology and management
of hypotension
Noninvasive Hemodynamic
Monitoring
• Major indications (cont’d)
• Monitoring after discontinuing a PA
catheter or justification for insertion of a
PA catheter
• Evaluation of pharmacotherapy
• Diagnosis of rejection following cardiac
transplantation
hemodynamic cases
Thanks
