HAEMODYNAMICS MONITORING

PATIENT S WITH PRE, INTRA, POST

CORONARY BYPASS SURGERY
 Hemodynamics

Interrelationships of physical
forces that affect circulation
 Why hemodynamics
monitoring is important in
critical care?

Monitoring used extensively in

patient assessment and decision
making
Nurses need to understand types
and meaning of data
 Lung

Left Pulmonal
atrium vein

SVR =
Right Systemic
Atrium Left
ventricle Vascular
Resistance

Right
ventricle

organ
PRINCIPLE OF HAEMODYNAMIC
H
E Pressure
M
O
D
Preload
Y
N Flow Afterload
A Contractility
M Heart rate
I
Resistence
C

CARDIOVASKULER
 HEMODYNAMIC
MONITORING

INVASIVE
NON INVASIVE
Intra Arterial Pressure
Central Venous Symptoms
Pressure
Pulmonary Artery
Pressure Physical Assesment
Left Atrial Pressure
Inspection
Palpation
Percussion
Auscultation
 Parameters of
Haemodynamic Monitoring
ECG
Also :
BP
Urine Output
CVP
Blood Gas
PCWP
Analysis
PA
Cardiac Enzim
SpO2
Temp
 Components of The Invasive
Hemodynamic Monitoring
1. The Catheter and manometer line low
compliance
2. The Pressure Transducer
3. The Flush Systems
4. The Oscilloscope and Strip Chart
Recorder

Vessels Catheter Transducer Monitor

Pressure Electric Wave and

Signal Signal Number
 Advantages and Disadvantages
Invasive Hemodynamic Monitoring
Advantages
Accuratly and can read tobe continous
Available value the cardiovascular system
monitoring which is not identified by
monitoring non invasive
Its used to optimal therapy
To take blood sample for measurement
Efficient of time

Disadvantages
Increases risk complications
Need to special training
Give wrong information
 To Ensure Accuracy of
Invasive Hemodynamic
Pressure Readings
1. Calibration of invasive
system to athmosphire
pressure

2. Determination of
phlebastatic axis for
transducer height
placement
The landmark, the phlebostatic axis, is the intersection of the fourth
intercostal space and midanterior posterior chest
 Intra Arterial Blood Pressure
Monitoring
The system is designed for continuous
measurement of systolic, diastolic and mean
arterial blood pressure by the catheter insert to
vessels and connect to monitoring system.

Formula, MAP = Systolic + (Diastolic x 2)

3
 Allen test
Adequate ulnar blood flow 5-7 seconds
If >15 seconds flow is unadequate
 Nursing interventions
Monitor waveform
Compare values with cuff
A-line should be more accurate reading
Check connections in system
Check site and circulation to
extremities
Set alarms
underdamped overdamped
 Masalah Penyebab Pemecahan

- Darah balik ke - Sambungan lepas - Cek sambungan dan

tubing - Stopcock tertutup kencangkan
ke flush system - Buka stopcock
- Tidak adekuat - Isi kantong tekanan 300
kantong tekanan mmHg

- Tidak ada - Sumber listrik mati - Cek aliran listrik

gambar - Tranducer tidak - Cek sistem
gelombang terbuka ke kateter - Hubungkan tranduser ke
- Tranducer tidak monitor
terhubung dgn
monitor
 Penyebab Intervensi Pencegahan

Seleksi skala tidak benar Set skala tekanan

Kateter tertekuk yg tepat
Reposisi kateter
- Gambar tekanan
damped
Ada udara pada sistem Keluarkan udara
Bekuan darah dari sistem
Koneksi lepas Aspirasi darah dari
Compliant tubing kateter, flush
Perubahan kondisi pasien Kencangkan koneksi
Inadekuat kantong tekanan Gunakan stiff tubing
Kaji dan treat pasien
Kembangkan kantong
tekanan 300 mmHg
 Penyebab Intervensi
- Pembacaan tidak Perubahan reference level
akurat transduser
Transduser diatas reference
point kesalahan hasil
pembacaan rendah
Transducer dibawah
reference point kesalahan
hasil pembacaan tinngi
Udara atau bekuan pd
sistem
Pencegahan
Pertahankan
transduser pada
plebostatic axis
atau kateter tip
level pada saat
melakukan
pembacaan
Cek sistem: aspirasi
udara atau bekuan
dari sistem
 Central Venous Pressure
(CVP) Monitoring

The measurement of pressure by

insert the catheter in central
venous or right atrium for fluid
volume information
 Pulmonary Artery
Catheter

1970
Dr. Swan and Ganz (Swan-Ganz is a brand)
Reflects left heart pressures
 During insertion
Monitor pressures in each chamber
Record values
Assess for complications
Dysrhythmias
Pneumo/hemothorax
 Cardiac Output
Measurement
Inject solution within 4 seconds
Increased accuracy at end
expiration
Check waveform obtained
Repeat at least three
measurements
Average values within 10% of each
other
Calculate CO and cardiac index
(computer does this)
 Cardiac Output vs. Index
Index is a better assessment; based
on body size
Uses body surface area
Calculated on the computer after
entering clients height and weight
 Complications

AIR Embolus: major complication

Hemorrhage: keep connections tight
Thrombosis
Infections
Arrhytmias
Rupture heart chambers
Pneumothoraxs
Haemothorax
 Pre Operative Monitoring
Need for Planning the Operation &
Post Operative Care & Estimation
of the operative risk.

Give the information about

historical diseases Requirement
of further diagnostic.
 Pre Operative Monitoring
Good contact and orientation its mean cerebral
circulation is adequate

Skin colour, cappilary reffil, and warm extremities it is

means peripheral circulations is adequate

Urine output : 1 ml/kgBW/hours it is means good renal

perfusion
Generally pre-operative monitoring is non invasive
include : ECG, NBP, Pulse Oximetry
* Pulse Oximetry
Monitoring noninvasive : estimate of arterial oxygen
saturation using the change in light absorption across
vascular bed during the arterial pulse

Sumber error
*Physiologic/anatomic
Vasoconstriction/poor perfusion
Abnormal hemoglobin
Skin pigmentation
False nails and polish

*External
Motion of sensor
Extraneous light
 Intraoperative Monitoring
Coronary Bypass
Surgery
CPB
Hypothermy
Possibility of reinfarction

HAEMODINAMIC
CHANGES
 Intraoperative Monitoring

Common Types of Monitoring

Arterial pressure monitoring
A-line
Pulmonary artery pressure & monitoring
PA catheter; Swan Ganz
Right atrial pressure monitoring
RAP; CVP
ECG, SpO2
 Immediately Post Operative
Period
Hemodynamic monitoring every 15
for the first 6 hours.

If stable every 1 hour

Monitoring include :
ECG, MAP, CVP, PCWP, CO, SVR, PVR,
SpO2, Temperature.
 CONSIDER COLABORATE OF
HAEMODYNAMIC STATUS FOR FURTHER
INTERVENTIONS

BP PCWP CO SVR PLAN

VOLUME

N N DIURETIC OR VENODILATOR
INOTROPE

VASODILATOR

INOTROPE/VASODILATOR/IABP

N N -AGENT
 CAUTION !!!
DONT TREAT THE MONITOR
BUT TREAT THE PATIENT

Efficient, safe use and manage of the

invasive hemodynamic monitoring to
need expert availability training
nursing