Documentos de Académico
Documentos de Profesional
Documentos de Cultura
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Purposes
Aid diagnosis of various cardiovascular
disorders
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A & P of the Heart
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Hemodynamic Monitoring System
• Basic components of the
monitoring system
• Noncompliant pressure tubing
• Transducer
• Amplifier
• Recorder
• Flush system
• Flush solution
• Infusion system
• Pressure bag
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Swan Ganz in Heart
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Hemodynamic Monitoring System (cont.)
• Zeroing and Leveling
• To avoid erroneous readings
• Position of the transducer
• The Phlebostatic axis
• If above---falsely low reading
• If below---erroneous elevated readings
• 2-mmHg change in pressure reading
• Zeroing the system
• 3-way stopcock off patient and open to air
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Hemodynamic Monitoring System (cont.)
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Swan Ganz Setup
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Swan in Patient
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Pulmonary Artery (PA)
Pressure Monitoring
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Pulmonary Artery (PA) Pressure Monitoring (cont.)
• Types of Catheters
• Thermodilution Paceport
for pacing probe (no ballon).
• VIP– additional proximal
lumen and port
• Thermodilution
7-7.1/2 French lumen
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Swan Ports
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Swan Ganz Waveforms
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Pulmonary Artery (PA) Pressure Monitoring (cont.)
Important ****
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Pulmonary Artery (PA) Pressure Monitoring (cont.)
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Pulmonary Artery (PA) Pressure Monitoring (cont.)
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Pulmonary Artery (PA) Pressure Monitoring (cont.)
• Complications
• Pneumothorax
• Infection
• Ventricular dysrhythmias- if catheter slip out of its place an fall to far
back in the R ventricles cause ventricular Dysthymias.
• Embolism -
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Cardiac Output
Review concepts related to Cardiac Function
• Cardiac output (CO) 48 L per Min if no exercise if exercise
• The amount of blood, in liters, ejected from the left ventricle each minute
• CO = HR x SV ( Heart rate x stroke volume)
• Normal CO for an adult: 4-8 L/min.
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Cardiac Output
• Stroke Volume
• Amount of blood ejected by the ventricle during systole, 60-100 ml/beat
•Three factors
• 1. Contractility-
• 2. Preload Fill
• Starling’s Law of the heart
• 3. Afterload push
• systemic vascular resistance
• pulmonary vascular resistance
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Cardiac Output cont.) Not important
• 10 ml of normal saline or D5W
• Room temperature (or Iced solution-old)
• A closed system: 10-ml syringe attached to the RA port by a stopcock
• Quick and smoothly inject in less than 4 seconds
• Three or more consecutive measurements
• See schematic representation (slope)
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Central Venous Pressure (CVP)
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Arterial Pressure Monitoring
• Uses
• Continuous monitoring of blood pressure
• Provides access for obtaining blood samples, relatively
closed setup, needleless
• Common sites
• Radial artery --- Allen’s test before putting radial arterial catheter.
Releasing and looking for circulation in that hand 7 second (ulnar
and radial arterial hold at the same time for 7 second and release
then check hand for flush of blood to make sure it’s blood
circulation).
Allen’s test: to test collateral blood flow, compress radial &
ulnar artery, while patient has hand elevated
opening/closing fist, then ulnar is released, should see
good color return to hand w/in 10 secs.
• Femoral artery
• Brachial artery
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Arterial Line Monitoring
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Arterial Line Setup
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Arterial Monitor Reading
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Arterial Pressure Monitoring (cont.)
• Waveform
• Rapid upstroke
• Ejection from the ventricle into the aorta
• Peak = systolic pressure
• Clear dicrotic notch
• Sudden closure of the aortic valve
• The end of ventricular systole or the beginning of diastole
• Definite end-diastole
• The lowest point
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Arterial Pressure Monitoring (cont.)
• Mean Arterial Pressure (MAP) use opposite arm check MAP and
compare with arterial line.
• Evaluate perfusion of vital body organs
• The average pressure in the peripheral arterial system during the entire
cardiac cycle
• Normal: 70 to 105 mmHg
• Need to maintain more than 60 mmHg to perfuse vital organs automatically
calculated & continuously displayed
• [Systolic BP + (2 x Diastolic BP)] ÷ 3
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Arterial Pressure Monitoring (cont.)
• Complications
• Infection
• Accidental blood loss
• Impaired circulation to extremity
• Embolism
• Nursing Considerations
• Ensure reading obtained are accurate (AL & SG)
• Level transducer and zeroing system
• Catheter patency (blood clot in tip, kinking of tubing, air bubbles)
• Long tubing (>4ft)
• Too many stopcocks, loose or open stopcocks
• Compare to manual cuff pressure, proper size cuff, proper placement
• Dampened waveform? Check stopcocks, tighten system, flush line, aspirate for air
or clots, change patient position, pt cough
• Monitor complications
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