Hemodynamic Monitoring

1. Hemodynamic
Monitoring
A BRIEF OVERVIEW
MAGALI ROMAN, LPN

2. Hemodynamic Monitoring
▪ Hemodynamic monitoring as defined by Ignatavicius & Workman (2012), is
an invasive system used to visualize information regarding patients vascular
capacity, blood volume, pump effectiveness as well as tissue perfusion. It is
a system that allows for direct measurements of pressures of the heart and
the great vessels.
▪ Components include a catheter with an infusion system, a transducer and a
monitor. Although it is the physician who orders and inserts the catheter,
nurses should know what we are looking at and how to interpret it. This type
of monitoring is usually used during critical care settings such as hypovolemic
shock and can determine physicians orders for future treatment as well as
provide evidence that the current treatment is being tolerated (pg. 708).
▪ There are several placement locations which can be used to monitor
including the pulmonary artery, right atrium, and radial, brachial, femoral or
dorsalis pedis arteries.

3. Pulmonary Artery Catheter
▪ A balloon-tipped, multi-lumen pulmonary artery catheter (PAC) also known
as the Swan-Ganz catheter is inserted by physician into the internal jugular
or subclavian vein and guided to the right atrium (RA). Once there, the
balloon is inflated and catheter advances with blood flow to the pulmonary
artery (PA). Balloon is deflated once in the PA. Placement confirmed with
x-ray (pg. 708).
▪ Normal RA pressure: 1-8 mm Hg. Normal PA pressure: 15/5-26/15 mm Hg.
Decreased RA pressure may = hypovolemia. Pressure measured during
balloon inflation is called the pulmonary artery wedge pressure (PAWP) and
reflects left atrial pressure. Normal ranges between 4-12 mm Hg. Elevated
PAWP may = left ventricular failure or hypervolemia (pg. 709). .
▪ Before recording pressure patient must be in supine position with head of
the bed at a 45 degree angle and the transducer must be at the level of the
phlebostatic axis (pg. 709). .
▪ Complications can include pulmonary rupture if catheter stays in wedge
position. Notify physician immediately if this happens. Air embolism,
ventricular dysrhythmias, thrombus, embolus and infections are also
possible. Catheter insertion site is covered with a sterile occlusive
dressing. Inspect site for signs of infection (swelling, drainage, redness,
hardness, etc.).

4. Central Venous Pressure Monitoring
As mentioned by emedicine.com as well as Ignatavicius & Workman
(2012), central venous pressure catheters (CVP) are also inserted by
a physician into the internal jugular vein guided by ultrasound
fluoroscopy. Anesthesia is utilized and can be done at the bed side
utilizing drapes and sterile technique. Equipment needed is the same
as for PAC. With a CVP catheter not only can we monitor pressures
from the right atrium or superior vena cava in critical patients but it
provides venous access for long term treatments like antibiotic
infusions, chemotherapy, and hemodialysis (pg. 819).

5. Arterial Pressure Monitoring
▪ Arterial lines (A-line) aide in providing continuous blood
pressure monitoring in critically ill patients. The
catheter is sterilely inserted into the radial or femoral
arteries, attached to pressure tubing and a normal
saline flush solution is infused under constant
pressure. A transducer is also attached.
▪ Direct arterial blood pressure is 10 to 15 mm Hg
greater than blood pressure cuff measurements.
▪ A-lines facilitate blood pressure readings for severely
burned, obese, or hypotensive patients, as well as
beneficial in the obtaining repeated blood samples for
ABG’s (arterial blood gasses).
▪ Complications include pain, infection, potential for air
embolism and hemorrhage.

6. References
http://emedicine.medscape.com/article/1824547-overview#a1
http://emedicine.medscape.com/article/1999586-overview
http://emedicine.medscape.com/article/1375734-overview#a1
Ignatavicius, D., Workman, L. (2012). Medical surgical nursing: patient-centered
collaborative care (Seventh ed.). St. Louis, MO: Elsevier/Mosby