com on it or ing
TRANSCRIPT
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Cardiac outputmonitoring
Inese Kutovaja09/07/2008ICU RPH
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CARDIAC OUTPUTMONITORING
Invasive
PA catheter
Non-invasive
TOE, EchocardiographyOesophageal doppler
AortovelographyTransthoracic impedance
Arterial pulse contour analysis (PiCC O) Arterial pulse power analysis (LiDC O)
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PULMONARY ARTHERYCATHETER
Also known as:PA Catheter
Swan-Ganz Catheter Swan
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PURPOSE
PA catheter is designed to measure:intra-cardiac pressurespulmonary artery pressurescardiac outputoxygen saturation
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CANDIDATES MI with complicationsCHFPulmonary H TN
Respiratory failure Shock Sepsis Trauma
Hemodynamic instability
High risk cardiac surgeryPeripheral vascular surgery
Aortic surgery Neuro surgery
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CONTRAINDICATIONS
Tricuspid or pulmonary valve mechanicalprosthesisRight heart mass (thrombus and/or tumor )
Tricuspid or pulmonary valveendocarditis
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F LOAT PA CATHETER
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DISTANCE MARKINGS
S iteS ubclavian veinInternal Jugular
Femoral vein
Distance to PA35-50 cm40-55 cm
60 cm
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PA CATHETER CROSSSECTION
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PROXIMAL PORT IN RIGHTATRIUM
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CVP WAVE F ORM
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RIGHT VENTRICULARPORT (orange)
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DISTAL PORT (yellow)
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PAP WAVE F ORM
S imilar in appearance to arterialwaveform
Waves Systolic pressure
Dicrotic notch End diastolic pressure
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PAP WAVE F ORM
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PAP
Low Volume depletion
Drugs
HighPulmonary H TNPulmonary Embolus
Mitral stenosisLV failure
Septal wall defects
Normal valuesPA systolic pressure = 20-30 mm HgPA diastolic pressure = 8-12 mm Hg
About 25/10
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Pulmonary Artery Occlusive
Pressure (PAOP)
Also known as:
Pulmonary capillary wedge pressurePC WPP WPPA W
Wedge pressure Wedge
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Pulmonary Artery
Occlusive Pressure (PAOP) Normal mean value
8-12 mm HgLow (< 8 mm Hg )hypovolemia
High (>12 mm Hg )hypervolemia
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Thermistor / Connector
Thermistor
Measures temperature of bloodThermistor connector Connects swan to display monitor
Sends temperature info to monitor
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PA Catheter Complications
Infection Air emboli
ThrombosisPA infarction
PA rupture Balloon rupture
ThrombocytopeniaCatheter knotting
Ventricular DysrhythmiasHemothoraxPneumothoraxCardiac Tamponade
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CO MEASUREMENT USING
PA CATHETER
1)Fick method/principle
2) Indicator dilution technique
-dye dilution
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CO MEASUREMENT USINGPA CATHETER
- thermo dilution
S teward-Hamilton equation:
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Temperature-versus-time
curve
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NON INVASIVE CARDIACOUTPUT MONITORING
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OESOPHAGEAL DOPPLERMeasurement of blood flow velocity in the
descending aorta at the tip of the flexible probe.
4 MHz continuous or 5 MHz pulsed wave
CO (cardiac output )SV (stroke volume )
FTc (corrected f low time )P V (peak velocity )MD (minute distance ) HR (heart rate )
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OESOPHAGEAL DOPPLER
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OESOPHAGEAL DOPPLER
Principle of strokevolume calculationfrom aortic
velocity ( V Ao ) measurements. The area under the maximum
aortic velocityenvelope ( VTI) represents thestroke distance
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OESOPHAGEAL DOPPLER
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OESOPHAGEAL DOPPLER
Normovolaemia : wide bases , tall peaks
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OESOPHAGEAL DOPPLER
Hypovolaemia: narrow waveform , low correctedflow time ,Good peak velocity , decreased C O, SV,
borderline HR
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LiDCOLithium Indicator DilutionContinuous , real-time cardiovascular monitoring
Minimally invasive Arterial pulse power analysis
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Advantages of the LiDCO
SAFE-Central/peripheral venous and arterial catheters-injectate is an isotonic (150 m M) solution of
lithium chloride-0.15 -0.30 mmol for an average adult-patient weight (> 40kg ) and absence of renal
dysfunction or dialysisACCURATES IMPL E TO USE
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LiDCO
Cardiac Output = ( Li th ium D ose x 60)/(A rea x (1 -P CV))
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LiDCO
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LiDCO
-cardiac shunt
-AF
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PiCCOPulse contour analysis with intermittent
thermodilution measurement.
Enables continuous hemodynamic monitoring using:- femoral or axillary artery catheter -central venous catheter
Adult or pediatric patients who have or may developpulmonary edema or ARD S are likely candidates
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PiCCOvia continuous pulse contour analysis
Continuous pulse contour cardiac analysis(PCC O)
Arterial blood pressure (AP )Heart rate (HR )
Stroke volume ( SV) Stroke volume variation ( SVV) Systemic vascular resistance ( SV R)
Index of left ventricular contractility
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PiCCOvia intermittent transpulmonary thermodilution
Transpulmonary cardiac output (C. O.)Intrathoracic blood volume (I TBV)
Extravascular lung water ( EVLW) (Not Available inUnited States)Cardiac function index (CFI )
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PiCCO
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PiCCO
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