HEMODYNAMIC MONITORING

“Heme” – blood
“Dynamus”- movement
Hemodynamics- movement of blood
Why do we care?
 Hemodynamic monitoring
-involves the measurement of blood flow and
pressure dynamics based on cardiac and
circulatory physiologic principles.
PURPOSE:
1. Aid in the diagnosis of various disorders
2. Assist in guiding therapies to minimize or
correct dysfunction
3. Evaluate patient response to therapy
 HEMODYNAMIC TERMINOLOGY
STROKE VOLUME-amount of blood leaving the
left ventricle with each contraction
SV =CO x 1000
HR
Expected Value 60-180 ml/beat
 CARDIAC OUTPUT
Amount of blood leaving the left ventricle per
minute.
CO=HR x SV
4 and 6 L/min
 CARDIAC INDEX(CI)
• More accurate measurement of circulation
than cardiac output
• Between 2.5 and 3L/min
• CI=CO
BSA

BSA= (weight in kg x 0.425) x (height in cm x

0.725) x 0.007184
 CONTRACTILITY
• Force generated by the contracting
myocardium
• The ability of the ventricles to contract or
squeeze against resistance is determined by
the contractile force
 PRELOAD
• The volume of blood in the ventricle at the
end of diastole
• Central Venous Pressure(CVP) and right atrial
pressure(RAP) measurements that reflect
venous return to the right side of the heart
 AFTERLOAD
• Pressure or resistance the ventricles must
overcome to eject blood during systole
 INTRA-ARTERIAL CATHETERS
Arterial Line- indwelling catheter inserted into an
artery by a health care provider or an advanced
practice nurse inorder to monitor BP
Inserted percutaneously or by surgical cutdown
technique
Indication-BP unstable, hypotensive, hypertensive
or receiving vasoactive medications that require
titration and monitoring
Never used for IV solutions and medications
• Provides continuous sampling of blood for
ABG without repeated punctures
 PULMONARY ARTERY CATHETERS
• Flow-directed, balloon tipped catheter
• Brand name: Swan-Ganz
• Catheters allow for assessment of cardiac
function, calculation of vascular resistance,
measurement of CO and infusion of IV fluids
 COMPLICATIONS
• Hemo-or pneumothorax
• Cardiac dysrhythmias
• Valvular damage
• Infection
• Air emboli
• Pulmonary artery rupture
 Hemodynamic Measurements
HEMODYNAMIC MEASURE COMPONENT BEING NORMAL RANGE
EVALUATED
Central venous Pressure Right Heart Preload 4-10mmHg
(CVP)
Pulmonary Artery Wedge Left Heart Preload 8-10mmHg
Pressure(PAWP)
Pulmonary Vascular Right Heart afterload 150-250 dynes/sec/cm-5
Resistance
Systemic Vascular Left Heart Afterload 900-1400 dynes/sec/cm-5
Resistance (SVR)
CO(cardiac output) Volume of blood pumped 60-80ml/beat
out of the left ventricle
In one beat
SVV(stroke volume Volume variation from one <13%
variation) heart beat to the next
EF(ejection fraction) SV expressed as a 60-80%
percentage