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Hemodynamic monitoring is
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Hemodynamic Monitoring is a diagnositc tool used for
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Swan-Ganz Catheters

Nursing

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Hemodynamic monitoring is the measurement of pressure, flow and O2 of the blood within the cardiovascular system
Hemodynamic Monitoring is a diagnositc tool used for continuous monitoring of force and flow of blood
hemodynamic monitoring is allows for monitoring response o therapies in terms of pressure, flow and O2 within the blood
Nurse's role within hemodynamic monitoring you must know the current treatments and how they work, focus on patient safety outcomes and be prepared to take action based on data
What are the hemodynmic monitoring system five basic components bedside manner, flush system, transducer, high pressure tubing, and catheter
The hemodynmic monitoring system's catheter measures from pulmonary artery, central venous, and arterial
Procedure for setting up the hemodynmic monitoring system Place 500cc bag of NS spiked c pressure tubing under the pressure bag & inflate to 300mmhg, prime tubing, level the lines with the patient, zero the lines, test the system and set alarms.
To ensure accuracy, why do you level hemodynmic monitoring system eliminate effects of hydrostatic pressure on transducer
where do you level hemodynmic monitoring system with phlebostatic axis (4th intercostal space, midaxillary line
How to you zero? turn stopcock and open to air
how do you caliberate using the biomed function of bedside monitors
Dynamic response /square T wave is tested tosee if the system is accurately transmitting the pressure detected in the vessel.
How to you do the dynamic response/square t wave test? pull the pig tail and release for a fast flush, should produce a square wave. Normal is 1-2 oscillations below the baseline
when is the dynamic response... done? after blood draws, or is accuracy is questioned, Q8-12 hrs
What is necessary to maintain patency and avoid clots? constant flow of sterile solution
why must connections be secured to withstand pressure
transducer position directly affects accuracy
When do you repeat leveling? every position, pole or bed change
When is zeroing done? every shift
Stroke volume is the amount of blood leaving the LEFT VENTRICLE with each CONTRACTION
What is a normal stroke volume? 60-100ml /beat
stroke volume is sensitive to changes in preload, afterload and contractility
Cardiac Output is the amount of blood leaving the LEFT VENTRICLE per MINUTE
CO= HR x SV
Normal CO is 4-8 L/minute
Where is the CO obtained? pulmonary artery catheter
Cardiac Index CO per square meter of the body; more accurate than CO
CI =CO/BSA
BSA is determined by (weight in Kg x .425)(height in cm(.725) x .007184
Normal CI is 2.2-4.0L / min
if CI is low it is not enough to perfuse to all organs = cellular death
Contractility are made of positive inotropes and negative inotropes
Positive inotropes catecholamines, sympathetic stimulation, drugs (digoxin, dopamine, dobutamine, epinephrine and norepinephrine)
negative inotropes acidosis, barbituates, alcohol, hypoxemia, drugs (progainamide, calcium channel blockers, and beta blockers)
Ejection fraction is the percentage of blood that is efected with each heart beat
normal ejection fraction is 65% (thus 35% is a reserve)
less than 35% ejection fraction is serious ventricular failure
Contractility is the force generated by the myocardium, related to the ability of the ventricle muscle fibers to lengthen/stretch
Frank-sterling law: cardiac muscle fibers will strtch to accommodate the venous return of diastole
what is the optimal filling pressure in contractility 10-12 mmhg
if greater than 12 than cardiac muscle fibers are overstretched and the force produced decreased leading to HF
Preload- R Atrial (CVP) reflects the pressure of the vena cava and RA, volume as well, but it is actually EDP
RV preload is dependent on RA blood colume, CO and venous vascular resistance
CVP/RAP 2-8 mmHg
Low CVP is hypovolemia
CVP is determined by CVP line of pulmonary artery catheter
Preload LVEDP (left Ventricular end diastolic pressure) is the volume of blood in a chamber at the end of diastole, and how we measure L V preload
Pulmonary Artery occlsive pressure is an indirect measure of the pulmonary capillary pressure and reflects the LVEDP under normal conditions
Normal PAOP = 6-12 mmHG
Pulmonary Artery can be used as an estimate if balloon is not working
you must have what to obtain LVEDP measurement? PAC
Reasons for High PAOP LV failure, myocardial failure, constrictive pericarditis, cardiac temponade, MV disease, fluid volume overload
Reasons for Low PAOP fluid volume deficit, shock states, vasodilating medications
Afterload the pressure the ventricles must overcome to eject blood
vascular resistance is the major determinant but also affected by resistance offered by aortic valave, mass and density of blood
SVR= (MAP-CVP) x 80/ CO
Pulmonary system afterload = PVR systemic ciculation = SVR
Normal PVR < 250 dynes/s/cm-5
SVR =800-1200 dynes s/cm-5
elevated SVR maybe due to hyperthermia, vasodilation, or drug therapy
invasive Pressure monitoring intra-arterial catheters, central venous catheters, pulmonary artery catheters
intra arterial catheters never for infusions, must fo an Allen's test first or a stick, radial artery is most common site, monitor continuous BP, used for those with unstable BP; those needing frequent blood draws/gasses; vasoactive meds requiring titration; careful monitoring
Arterial Waveforms sys/and dystolic pressure by the heart' mechanical activity, dicrotic notch is aortic valve cloorue end of systole and begining of dystole
factors influencing ABP waveforms cardiac arrhythmias , distance between heart and catheter site
MAP ((2*DBP)+SBP)/3
Created by: Hoopster
 

 



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