Hemodynamic monitoring r weinzierl

Editor's Notes

• #4: From working at the hospital I saw one in clinical, but I work on a progressive unit so I see ART lines often.. as well as some CVPs. Clinical in ICU Critical care clinical Clinical, internship, capstone Clinical ICU Capstone Clinical
• #12: The normal peripheral arterial waveform will display the peak systolic pressure after the QRS. This phenomenon reflects the time it takes the cardiac systolic pressure wave to reach the peripheral catheter and sensor. The dicrotic notch reflects the closure of the aortic valve. The same time delay applies to the dicrotic notch. The aortic valve has closed prior to the display of the notch. The time delay is a function of both distance and compliance or elasticity of the vessels. The waveform of a patient with arteriosclerotic disease would be steeper in ascent and descent, therefore shorter in duration and the notch would be less well defined.
• #17: The A wave starts just after the P wave ends and represents the atrial contraction. The high point of the A wave is the atrial pressure at maximum contraction. During the A wave the atrial pressure is greater than the ventricular diastolic pressure. At that point, the atrium is contracted, the tricuspid is open. Therefore, the high point of the A wave closely parallels the right ventricular end diastolic pressure. Remember, when the tricuspid valve is open and the right ventricle is full, the ventricle, atrium and vena cava are all connected. Therefore, that point is the CVP.
• #19: Provides direct measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure of the left atrium (wedge pressure) Provides diagnostic information to rapidly determine hemodynamic pressures, cardiac output, and blood sampling for mixed venous oxygen saturation. The pulmonary artery catheter offers several advantages over central venous pressure monitoring. When the balloon tip of a Swan Ganz catheter is properly wedged in a branch of the pulmonary artery, the pressure sensed by the catheter tip represents that in the left atrium, taking aside a specific problem of pulmonary capillary wedge pressure monitoring in the septic patient. Left atrial pressure, which equals left ventricular filling pressure in the absence of mitral stenosis, is an excellent indicator of the adequacy of fluid resuscitation done. If the pressure is low (less than 12 mmHg), additional fluid resuscitation is indicated. If the pressure is high (greater than 20 mmHg), additional fluid is unlikely to improve cardiac performance further, and vasopressors are probably indicated for circulatory support. Although the catheter can yield a vast amount of information (see table III), the distinction between the need of fluids or vasopressors is its most useful application.
• #20: The proximal port, commonly termed the CVP port, is used to measure right atrial or central venous pressure. It is also used for medication infusion and fluid boluses for cardiac output measurement. The distal port is used for PA pressure measurements and PCWP measurements when the balloon is inflated. Mixed venous blood gases can also be drawn from this port. The balloon port which is located at the tip of the catheter is inflated with a small amount of air (less than 1.5cc). When inflated, this balloon allows the catheter to float into a pulmonary artery branch vessel. This is refered to as a wedge position. This position allows pressure measurements to be made that indirectly reflect left ventricular end diastolic pressure. The distal (pulmonary artery) port also allows sampling of mixed venous blood for the assessment of oxygen transport balance and the calculation of derived parameters such as oxygen consumption, oxygen utilization coefficient, and intrapulmonary shunt fraction. The thermistor port is connected to the patient’s monitor via a cable and allows the display of continuous temperature readings. These temperature readings are essential to calculate cardiac output measurements. The actual thermistor is located just proximal to the balloon. In order to determine the cardiac output value, cool injectate is delivered rapidly through the proximal port of the PA catheter. A temperature curve is plotted over time as the cool injectate causes the pulmonary artery temperature to fall. It then rises back to the previous core temperature as warm blood continues in circulation.
• #21: Continuous pressure monitoring during PAC insertion is required to determine location of the catheter tip. During the insertion procedure, the first waveform will be the right atrial pressure. This wave will resemble a CVP wave. The following waveform will be the right ventricular pressure as the catheter passes through the right ventricle. During this time, the patient may experience some ventricular dysrhythmias that disappear as soon as the catheter exits the right ventricle. The catheter will enter the pulmonary artery and this will be its resting place for the majority of the time. Finally, when the balloon is inflated, the catheter will float into the pulmonary capillary and the resulting waveform will be the wedge pressure. The following diagrams illustrates the waveforms associated with inserting the pulmonary artery catheter.
• #22: http://www.youtube.com/watch?v=7putxZN7ij4 During the insertion procedure, the first waveform will be the right atrial pressure. This wave will resemble a CVP wave. The following waveform will be the right ventricular pressure as the catheter passes through the right ventricle. During this time, the patient may experience some ventricular dysrhythmias that disappear as soon as the catheter exits the right ventricle. The catheter will enter the pulmonary artery and this will be its resting place for the majority of the time. Finally, when the balloon is inflated, the catheter will float into the pulmonary capillary and the resulting waveform will be the wedge pressure. The following diagrams illustrates the waveforms associated with inserting the pulmonary artery catheter.