hemodynamic monitoring

1. HEMODYNAMIC
MONITORING

2. MEANING
 Specialized methods used to evaluate
cardiovascular performance
 Measurement of pressure, flow and
oxygenation within the CVS

3. METHODS
 Invasive / direct
 Arterial catheters
 Central venous catheters
 Pulmonary artery catheters
 Non invasive/ indirect
 BP cuff
 Echo doppler

4. GOALS
 Maintain adequate tissue perfusion by
assessing the body’s response to tissue oxygen
demands
 Alert the healthcare team of an impending
cardiovascular crisis before organ injury occur
 Evaluate immediate response to treatment
modalities

5. INDICATIONS
 All shock states (cardiogenic, neurogenic,
anaphylactic, septic, and hypovolemic)
 Loss of cardiac function
 Decreased cardiac output

6. MECHANISMS DETERMINING CO
 Preload
 Afterload
 Contractility
 Heart rate

9. CONCEPTS / ELEMENTS
1. Heart rate and Stroke volume
2. Cardiac output
3. Blood pressure
4. Arterial pressure
5. Central venous pressure
6. Pulmonary artery pressure
7. Arterial and Mixed venous oxygen saturation
(SvO2)

10. 1. Heart rate and Stroke volume
• Not only is the rate important, the rhythm can cause
hemodynamic imbalances.
• SV is the amount of blood pumped out of the ventricle with
each contraction.
• 60 – 100 mL/beat.
• This volume can be altered when
 the heart rate is too fast
 the rhythm is too irregular
 Change in the cardiac muscle mass happens.

12. 2. CO
 Cardiac output is the amount of blood that is
pumped out of the ventricles in one minute.
 4-8 L/minute.
 CI= CO/BSA

13. 3. BLOOD PRESSURE
 Systolic blood pressure
 SV, wall compliance, PVR
 Diastolic blood pressure
 Blood vol, wall compliance, PVR
 Mean arterial pressure
[SBP+2(DBP)]/3

14. 4. ARTERIAL PRESSURE
 Radial artery- collateral blood flow, femoral, brachial
 Wave form variations: BP, dysrhythmias,
mechanical factors
 MAP: 70-100mmHg

16. 5. CENTRAL VENOUS PRESSURE
 Right atrial pressure/ pressure of great vein in
thorax
 SC, IJV / EJV, median basilic or femoral
 Sternum: 0–14 cm H2O
 Midaxillary line: 8–15 cm H2O
 8-12mmHg
 Complications
 Insertion: pneumothorax, hemothorax, air embolism,
hematoma, cardiac tamponade
 Catheter: infection, air embolism, thrombus

17. 6. PULMONARY ARTERY PRESSURE
 Swan Ganz catheter
 Systolic PAP: 20-30mmHg
 Diastolic PAP: 8-12mmHg
 Mean PAP: 15-20mmHg
 PAWP: 6-12mmHg

20. 7. MIXED VENOUS O2 SATURATION
 PA catheter
 Identify Ventilation perfusion mismatch
 60-80%

21.  Coronary perfusion pressure : 50-70mmHg
 SVR : 900-1200 dynes/sec/cm-5
 PVR : 60-100 dynes/sec/cm-5

22. NEWER TECHNOLOGY
 Thoracic electrical bioimpedence
 Pulse contour device
 Modified PA catheter to monitor CO
 Esophageal doppler CO
 EF measurement
 Exhaled CO2 monitoring

24. REMOVAL
 Skilled person
 Pressure applied
 Verify bleeding cessation
 Band aid

25. COMPLICATIONS
 Bleeding/ bruising
 Hemorrhage
 Air embolism
 Thrombosis
 Decreased blood flow to
distal
 Vascular erosions
 Improper vascular
placement
 Infection
 Neuromuscular injury
 Fluid overload
 Chest trauma
 Dysrhythmias
 Cardiac perforation
 Rupture of vessels
 Knotting/looping/entanglem
ent
 Pulmonary infarction/
ischemia

26. THANK YOU