pa catheter ppt
TRANSCRIPT
04/11/23 1
HEMODYNAMIC MONITORING
OBJECTIVE
04/11/23 2
1. Describe the three attributes of circulating blood and their relationships.
2. Identify types of clients in which hemodynamic monitoring would be indicated.
3. Describe the types of catheters used for hemodynamic monitoring.
4. Discuss the normal and abnormal values obtained through hemodynamic monitoring as they relate to specific client situations.
5. List the potential complications in use of hemodynamic monitoring devices.
6. Explain nursing responsibilities when caring for patient on hemodynamic monitoring.
7. Describe the procedure for setting up a hemodynamic circuit.
HEMODYNAMIC MONITORING
04/11/23 3
• DEFINITION:Using invasive technology to provide quantitative information about
vascular capacity, blood volume; pump
effectiveness, and tissue perfusion
HEMODYNAMIC MONITORING
04/11/23 4
• ATTRIBUTES OF CIRCULATING BLOOD:
1. PRESSURE 2. RESISTANCE 3. Flow
HEMODYNAMIC MONITORING
04/11/23 5
• TYPES OF CATHETERS USED FOR HEMODYNAMIC MONITORING: 1. Pulmonary Artery Catheter
(swan ganz)
2. Arterial Pressure Catheters
3. Central Venous Pressure or CVP monitoring
HEMODYNAMIC MONITORING
04/11/23 6
• INDICATIONS FOR HEMODYNAMIC MONITORING:
1. Potential or actual alteration in
CO
2. Potential or actual alteration in fluid volume
HEMODYNAMIC MONITORING
04/11/23 7
• PULMONARY ARTERY MONITORING EQUIPMENT
1. Invasive catheter (swan ganz) 2. Transducer 3. Amplifier/recorder
HEMODYNAMIC MONITORING
04/11/23 8
• SWAN GANZ CATHETER
a. Distal Lumen: the PA (pulmonary artery)b. Proximal Lumen: (CVP port) c. Inflation Balloon D. Thermostat Lumene. Additional Lumens * VIP - venous infusion port
* Pacing Port-
04/11/23 9
HEMODYNAMIC MONITORING
04/11/23 11
• Assessment Data, Pressures, Waveforms of the swan ganz catheter
a. RAP or CVP b. PAP - c. PCWP (PAWP) d. Waveforms: RAP, RVP, PAP, PCWP e. Using Pressures to Calculate Other
Hemodynamic Variables * CO, CI, MAP, SVR, PVR
HEMODYNAMIC MONITORING
04/11/23 14
• NURSING RESPONSIBILITIES 1. Pre-Insertion: a. Patient & significant others
teaching. b. Thorough baseline assessment
c. Equipment set-upd. Positioning of the cliente. Equipment check (calibration, zero
etc.)
HEMODYNAMIC MONITORING
04/11/23 15
NURSING RESPONSIBILITIES 2. Insertion, (patient is often awake for the
procedure) a. Collaboration b. Assist with equipment preparationc. Monitor patients response to
treatmente. Recording
HEMODYNAMIC MONITORING
04/11/23 16
NURSING RESPONSIBILITIES 3. Post-Insertion a. Chest X-ray for placemenb. Sterile OCCLUSIVE dressing, stabilization
of the catheterc. Patient comfortd. Assess and document pressures/datae. Catheter maintenancef. Monitor patients response
HEMODYNAMIC MONITORING
04/11/23 17
NURSING RESPONSIBILITIES • Maintenance of the System: a. Label and date lines, change tubing as per unit policy b. Maintain & change dressing c. Alert for waveform and pressure changes d. Maintain pressure/pressure bag e. Keep balloon deflated between PCWP readings
f. Collaboration and communication with physician
g. Remember to care for the patient as well as your equipment
Zeroing
• hydrostatic pressuremeasurements• CVP of 10 mmHg at an atmospheric pressure
of 760 mmHg is actually 770 mmHg.
21
Phlebostatic Axis
• 4th intercostal space, mid-axillary line
• Level of the atria
(Edwards Lifesciences, n.d.)
23
Dynamic Flush
Dynamic flush ensures the integrity of the pressure tubing system. Notice how it ascends - forms a square pattern - and bounces below the baseline before returning to the original waveform.•Check dynamic flush after zeroing any pressure tubing system
HEMODYNAMIC MONITORING
04/11/23 28
• POTENTIAL COMPLICATIONS 1. Dysrhythmias
2. Infection 3. Pneumothorax4. Pulmonary infarction 5. Balloon rupture and air embolism6. Pulmonary artery rupture
7. Endocarditis
HEMODYNAMIC MONITORING
04/11/23 29
• ARTERIAL PRESSURE MONITORING: 1. Indications 2. Assessment data: * MAP = (diastolic x 2)+(systolic)
3
* MAP - ICP = CPP
HEMODYNAMIC MONITORING
04/11/23 30
• ARTERIAL PRESSURE MONITORING:3. Arterial Waveform a. Aortic valve opens and blood is ejected
from LV and is recorded as an increase in pressure
b. Highest point represents systole
c. Lowest point is diastolic pressure
HEMODYNAMIC MONITORING
04/11/23 31
• ARTERIAL PRESSURE MONITORING:• 4. Nursing Responsibilities• 5. Potential Complications: a. Thrombosis at catheter tip
b. Infection c. Bleeding d. Loss of flow distal to extremity
Nursing Responsibilities
04/11/23 32
• Prepare the setup and the circuits• Assist in the procedure • Caring for equipments as well as for the
patient.• Calibration• Obtaining the readings• Interpreting the results and informing the
physician• Providing the suitable management• Documenting
04/11/23 33
Swan Ganz Cathetarization
PROCEDURE FOR SETTING UP A HOMODYNAMIC CIRCUIT
04/11/23 34
• Equipment Required: 1. 2 single transducer kit 2. 2 Pressure bags
3. 2 500 mL bag of .9 NaCl with1,000 units of
heparin 4. 2 transducer clamp 5. 2 pressure cable connected to Protocol
monitor
04/11/23 36
04/11/23 37
04/11/23 38
04/11/23 39
04/11/23 40