INVASIVE HEMODYNAMIC MONITORING Arterial Blood PressureABP Central Venous

INVASIVE HEMODYNAMIC MONITORING ü Arterial Blood Pressure(ABP) ü Central Venous Pressure(CVP) ü Pulmonary Artery Pressure(PAP) ü Pulmonary Capillary Wedge Pressure(PCWP, PAWP) ü Cardiac Output(CO)

PULMONARY ARTERY PRESSURE

• INDICATION – Haemodynamic measurement(cardiac output, stroke volume, systemic vascular resistance) – Measurement of right heart pressure(RAP, PAP) – Acute pulmonary hypertension – Pulmonary embolism – Cardiac tamponade – Estimation or preload/left heart filling(PAOP) – Derivation of oxygen variables(VO 2)

Components of Swan-Ganz [con’t] • Normally has four[4] ports – Proximal port – [Blue] used to measure central venous pressure/RAP and injectate port for measurement of cardiac output – Distal port – [Yellow] used to measure pulmonary artery pressure – Balloon port – [Red] used to determine pulmonary wedge pressure; 1. 5 special syringe is connected – Infusion port – [White] used for fluid infusion

Nursing considration • Asist with insertion and removal of invasive hemodynamic lines. • Asist with Allen test before canulation. • CXR after insertion of pulmonary catheter • Zero and calibrate equipments each 4 -12 hour • Monitor hemodynamic parameters and waveforms • Compare hemodynamic parameters with clinical conditions • Complications of catheters • instruct patient and family on theraputic use of hemodynamic catheters

• Pulmonary artery pressure: – measured by indweling catheters PA systolic=20 -30 mm. Hg PA diastolic=5 -10 mm. Hg PAP mean=10 -15 mm. Hg • (PAOP); artery occluson pressure: – wedge pressure or filling pressure in pulmonary vasculature when mitral is open 5 -12 mm. Hg

Invasive BP Monitoring Via Intraradial or Intrafemoral or Intrabracial Catheter

Ø Ø Ø Hemorrhage Ischemia Embolism Arteriospasm Infection Necrosis Complications:

ARTERIAL PRESSURE INDICATIONS – Routine measurement of systemic blood pressure in icu – Multiple blood gas analysis PREFERABLE SITES – Radial, femoral, dorsalis pedis CANNULATION – Collateral perfusion can be evaluated by modified allens test

COMPLICATIONS – Infection – Thrombosis – Digital ischemia – Vessel damage – Bleeding, Necrosis, Hemotoma

• • Arterial pressure monitoring – A-line • • Pulmonary artery pressure monitoring – PA catheter; Swan-Ganz • • Right atrial pressure monitoring – RAP, CVP