Beruflich Dokumente
Kultur Dokumente
Monitoring
BHM
BHM 11
®
BHM
BHM 22
®
BHM
BHM 33
®
Objectives
• Review:
– Biological sensors and monitoring
– Pulse oximetry
– Automated blood pressure devices
– Arterial, central venous, and pulmonary
artery catheters
– Cardiac output and oxygen delivery variables
BHM
BHM 44
®
Cardiovascular system
BHM
BHM 55
®
Macro Circulation Monitoring
• Traditional Clinical Parameter
– Heart Rate
– Blood Pressure
– Urine Output
– Hemodynamic Measurement
• CVP
• PAWP
• RVEDVI
BHM
BHM 66
®
Micro Circulation Monitoring
• Global Parameter
–Oxygen Delivery Index ( DO2I )
–Oxygen Consumption Index (Vo2I)
–Mixed Vein O2 Saturation ( SvO2 )
–Serum Lactate
–Base Deficit
–Arterio-Venous Carbon Dioxide
Gradient ( AVPCO2 )
• Organ Specific
– Gastric Chronometry
– Sublingual Capnometry
BHM
BHM 77
®
Parameter Singkatan Rumus Rentang Normal
Indeks jantung CI CO/BSA ÷ 1000 2,5-4,3 L/menit/m2
Tekanan arteri rata-rata MAP 2(DBP) + SBP 3 70-105 mmHg
Tekanan arteri kanan RAP cm H2O = mmHg × 1,34 2-8 mmHg
Index kerja sekuncup ventrikular kanan RVSWI (PAD-RAP) SV × 0,0138 BSA 7-12 g.m/m2
Index kerja sekuncup ventrikular kiri LVSWI (MAP-PAOP) SV × 0,0138 BSA 35-85 g.m/m2
BHM
BHM 99
®
Pulse Oximetry
• Estimates oxyhemoglobin as
SpO2 – goal 92%–94%
• Heart rate displayed should be
same as pulse rate or ECG
heart rate
BHM
BHM 10
10
®
Oxyhemoglobin Saturation Curve
BHM
BHM 11
11
®
Oximeter Sensors
BHM
BHM 12
12
®
Pulse Oximetry - Sources of Error
• Physiologic/anatomical
– Vasoconstriction/poor perfusion
– Abnormal hemoglobin
– Skin pigmentation
• External
– Motion of sensor
– Extraneous light
BHM
BHM 13
13
®
Automated Blood Pressure
Devices
• Non-Invasive monitoring
• Intermittent measurements
• Appropriate cuff size necessary
• Less accurate during
hypotension, arrhythmias
BHM
BHM 14
14
®
Arterial Cannulation
• Indications
– Multiple arterial blood samples
– Continuous blood pressure
( invasive arterial monitoring )
• Sites
• Complications
– Hematoma/blood loss
– Thrombosis/distal ischemia
– Arterial injury
– Infection
BHM
BHM 15
15
®
Sites and sizes of artery cannulation
Dewasa Anak
Radialis 20 – 22 22 – 24
Femoralis 20 -18 20 -22
Axillary 20 -
Dorsalis Pedis 20 -22 22 – 24
BHM
BHM 16
16
®
Central Venous Cannulation
• Indications
– Measure central venous pressure
– Access for resuscitation
– Selected drug administration
– Placement of pulmonary artery
catheter
• Complications
– Hematoma/vessel injury/blood loss
– Pneumothorax/hemothorax
– Cardiac arrhythmias
– Infection
BHM
BHM 17
17
®
Pulmonary Artery Cannulation
• Indications
– Obtain specific hemodynamic data
• Pressure monitoring : RA,RV,PA,PAWP
• Flow monitoring : RV CO
• Oxygen saturation: mixed veins SvO2
• Complications
– Same as central venous cannulation
– Myocardial or pulmonary artery injury
– Catheter knots (rare)
BHM
BHM 18
18
®
Pulmonary Artery Catheter Insertion
BHM
BHM 19
19
®
Monitoring Components
• Proper catheter position
• Fluid-filled tubing and flush
connections to transducer
• Transduction of pressure
into electrical signal
• Signal processing and
display
• Leveling of transducer
• Appropriate calibration
BHM
BHM 20
20
®
Determinants of Cardiac Output
afterload contractility
Cardiac
Output
BHM
BHM 21
21
®
Determinants of CO and their assessment
variable Method of assessment
Heart and Rhytm Finger on the pulse
Pulse oxymetry
ECG
Preload
Right Heart Neck Vein distension, Liver enlargement
CVP
BHM
BHM 23
23
®
Heart rate assessment
• Normally 60-100 beats/min
• Bradycardia
– Parasympathetic stimulation
– Abnormality conduction
– Physiological bradycardia
• Tachycardia
– Heart compensated : hypovolemis, anemia,
fever, anxiety, pain etc
BHM – drugs
BHM 24
24
®
Oxygen Assessment Goals
•
Evaluate if oxygen supply (DO2) or oxygen demand
(VO2) are abnormal or imbalanced
• O2 supply
•
– DO2 = CO CaO2 10
where: CaO2 = (Hgb x 1.37 x SaO2) + (0.003 PaO2)
• –
• O2 consumption
– – –
– VO2= CO (CaO2 - CvO2) x 10
where: CvO2 = (Hgb 1.37 SvO2) + (0.003 PvO2)
BHM
BHM 25
25
®
Assessment Goals
•
• Balance of O2 supply (DO2) and O2 demand (V•O2)
• Determinations required
– Arterial and venous O2 content
• Hemoglobin
• Arterial/venous oxygen saturation
• Arterial/venous PO2
– Cardiac output
BHM
BHM 26
26
®
Take home message
• Any monitoring devices requires familiar operation and
potensial complication
• Pulse oxymetry should applied to patient with unstable
physiology
• Automated BP less accurate in such clinical situations
like shock, MV and arrhytmia, and arterial cannula need
to establish
• Primary goal of hemodynamic support is oxygen for
cellular and need to analysis oxygen balance
• Risk-Benefit of Pulmonary arterial catheter need to be
considered
BHM
BHM 27
27
®
Thank you
BHM
BHM 28
28
®