What is hemodynamics?

Movement of blood through the system

How do you measure hemodynamics?

BP, HR, SaO2, Skin Color, Cap refill, mucous membranes, any subjective data

Hemodynamic monitoring

An invasive method that measures: pressure, flow, oxygenation, and indirect measure of volume

What does the data from hemodynamic monitoring tell you?

it gives a picture of hemodynamic status

What is central venous pressure?

pressure on the venous side, a type of invasive monitoring

What are thermidilution techniques?

Indirect measures of LV volumes at end diastole

What do Oximetric Pulmonary Artery Catheters measure?

Pulmonary Artery pressures plus automated CO/CI and SvO2

What do Left Arterial Lines measure?

give a direct measure of the pressure in the Left atrium (Used in cardiac surgery patients)

Where are arterial lines placed?

they are placed in any large peripheral artery

Name some arteries that you can place an Aline

Radial, Brachial, Femoral, Dorsalis Pedis

What test must you perform before placing an Aline in the radial artery?

The Allen's test

What is the purpose of an Aline?

to monitor Arterial BP, easy access for lab draws, easy access for blood gas determination

What is PaO2? What is the normal range?

the partial pressure of oxygen in arterial blood. Range 92% and above

What is PaCO2? What is the normal range?

Partial Pressure of arterial Carbon Dioxide. range 35-45, Measure of bicarb in the blood.

What is pH? What is the normal range?

measure of the acidity or basicity of the blood. Range 7.35-7.45

What is HCO3? What is the normal range?

Bicarbonate Ion. range 22-26

When do we use A Lines?

anytime there are wide fluctuations in BP, when you have to manipulate vasoreactive drips, hyper or hypotensive crisis, if there is a need for multiple lab draws

What nursing considerations would you expect with A Lines?

R/f infection, losing blood volume due to d/c a line which can cause pt to bleed out, Requires careful monitoring

What are the benefits of an A Line?

continual BP monitoring, Easy lab draws

What are the disadvantages of an A line?

can damage arteries, can block perfusion to the limb,

What is Central Venous Pressure?

direct measure of pressure in R atrium and Vena Cava.

What does CVP tell you?

indicates relative volume status, it is a preload indicator, can reflect primary lung problems

How is a CVP inserted?

long catheter is placed in a large vein

Where is the CVP placed at?

tip of catheter is in the distal 1/3 of the vena cava just before the R atrium

How are all of these pressures measured?

MMHg

What is a normal CVP pressure?

2-6 mmHg

What does elevated CVP indicate?

high volume state

What does decreased CVP indicate?

low volume state

When do you use CVP monitoring?

used when we want to easily manage volume in a pt

Who is the likely candidate for CVP?

Any pt with high or low volume states and decreased CO

What are the nursing considerations with CVP?

Infection, R/F disconnection of line and bleeding out

What are the advantages of CVP?

Makes treating volume deficiencies, and overloads more efficient

What are the disadvantages of CVP?

makes pt immobile, puts them basically on bed rest to prevent DC of the catheter

How do you read an A line waveform?

the top of the line is systolic, the bottom is diastolic. You need both of these to calculate MAP

How is a PA cath inserted?

The balloon is inserted into a large vein, and then allowed to float along with the flow of the blood and then lodges into the small branch of the pulmonary artery.

What should you be watching for when you are inserting a PA cath?

Watch for atrial and ventricular arrhythmias, watch your EKG

What is a PA cath used for?

PA pressures, Pulm. cap. wedge pressure, Systemic vascular resistance, Pulm, vascular resistance, Manual CO/CI measurement using thermodilution, indirect measure of LV volumes at end diastole, Mixed venous blood sampling

What is pulmonary capillary wedge pressure?

the pressure measured in a pulmonary artery distal to an occlusion of that artery

What is systemic vascular

the resistance to flow that must be overcome to push blood through the

resistance?

circulatory system.

What is pulmonary vascular resistance?

the resistance offered by the vasculature of the lungs

What is the normal for CI?

2.2 or greater

What is the normal CO?

4-8L

Why is CI used more than CO?

CI is a number that can be used for all pts, CO is specific to the pt

Pa pressures are good for monitoring:

valve problems, heart failure, shock, sepsis, volume management

What do high PAP's indicate?

increased volume states, increased vascular resistance, Cor Pulmonale, HF

What is Cor Pulmonale?

damage or failure to the right side of the heart caused by long term high BPs in the PA and R ventricle

What do low PAPs indicate??

volume deficits, vasodilation states (shock)

What do preload indicators measure?

VOLUME

What do afterload indicators measure?

PRESSURE

What is the range for MAP?

70-105 mmHg

What is MAP?

COxSV+CVP

What is the range for PAMP?

10-20 mmHg

What does PAMP indicate?

the volume in the left side of the heart

What are the nursing considerations for pts with invasive pulmonary artery monitoring?

Infection, arrhythmia problems, immobility

What is Mixed Venous O2 Sat?

it is a balance of oxygenated blood b/t: Arterial blood, tissue perfusion, and tissue oxygenation

What do Mixed Venous O2 sats indicate?

it is a direct indicator of CO and tissue perfusion

If Mixed venous O2 sats fall, what could that be?

falling Mixed venous oxygen sat. can indicate shock states

Normal MVO2 sat

60-80% balanced and meets metabolic demand

What are the nursing implications for continuous MVO2sat?

Infection, monitor for sudden increases and decreases that indicate changes in oxygenation

What causes High MVO2sat?

increased oxygen supply, decreased oxygen demand (80-90%)

What causes low MVO2sat?

decreased oxygen supply, loss of hemoglobin, low O2 sat of hemoglobin, low CO, increased tissue oxygen consumption

How will a pt present with low MVO2 sats?

restless, shivering increased temperature, moving around a lot