PA Catheter Ppt

transcript

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HEMODYNAMIC MONITORING

OBJECTIVE

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1. Describe the three attributes of circulating blood and their relationships.

2. Identify types of clients in which hemodynamic monitoring would be indicated.

3. Describe the types of catheters used for hemodynamic monitoring.

4. Discuss the normal and abnormal values obtained through hemodynamic monitoring as they relate to specific client situations.

5. List the potential complications in use of hemodynamic monitoring devices.

6. Explain nursing responsibilities when caring for patient on hemodynamic monitoring.

7. Describe the procedure for setting up a hemodynamic circuit.

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• DEFINITION:Using invasive technology to provide quantitative information about

vascular capacity, blood volume; pump

effectiveness, and tissue perfusion

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• ATTRIBUTES OF CIRCULATING BLOOD:

1. PRESSURE 2. RESISTANCE 3. Flow

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• TYPES OF CATHETERS USED FOR HEMODYNAMIC MONITORING: 1. Pulmonary Artery Catheter

(swan ganz)

2. Arterial Pressure Catheters

3. Central Venous Pressure or CVP monitoring

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• INDICATIONS FOR HEMODYNAMIC MONITORING:

1. Potential or actual alteration in

2. Potential or actual alteration in fluid volume

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• PULMONARY ARTERY MONITORING EQUIPMENT

1. Invasive catheter (swan ganz) 2. Transducer 3. Amplifier/recorder

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• SWAN GANZ CATHETER

a. Distal Lumen: the PA (pulmonary artery)b. Proximal Lumen: (CVP port) c. Inflation Balloon D. Thermostat Lumene. Additional Lumens * VIP - venous infusion port

* Pacing Port-

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• Assessment Data, Pressures, Waveforms of the swan ganz catheter

a. RAP or CVP b. PAP - c. PCWP (PAWP) d. Waveforms: RAP, RVP, PAP, PCWP e. Using Pressures to Calculate Other

Hemodynamic Variables * CO, CI, MAP, SVR, PVR

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• NURSING RESPONSIBILITIES 1. Pre-Insertion: a. Patient & significant others

teaching. b. Thorough baseline assessment

c. Equipment set-upd. Positioning of the cliente. Equipment check (calibration, zero

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NURSING RESPONSIBILITIES 2. Insertion, (patient is often awake for the

procedure) a. Collaboration b. Assist with equipment preparationc. Monitor patients response to

treatmente. Recording

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NURSING RESPONSIBILITIES 3. Post-Insertion a. Chest X-ray for placemenb. Sterile OCCLUSIVE dressing, stabilization

of the catheterc. Patient comfortd. Assess and document pressures/datae. Catheter maintenancef. Monitor patients response

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NURSING RESPONSIBILITIES • Maintenance of the System: a. Label and date lines, change tubing as per unit policy b. Maintain & change dressing c. Alert for waveform and pressure changes d. Maintain pressure/pressure bag e. Keep balloon deflated between PCWP readings

f. Collaboration and communication with physician

g. Remember to care for the patient as well as your equipment

Zeroing

• hydrostatic pressuremeasurements• CVP of 10 mmHg at an atmospheric pressure

of 760 mmHg is actually 770 mmHg.

Phlebostatic Axis

• 4th intercostal space, mid-axillary line

• Level of the atria

(Edwards Lifesciences, n.d.)

Dynamic Flush

Dynamic flush ensures the integrity of the pressure tubing system. Notice how it ascends - forms a square pattern - and bounces below the baseline before returning to the original waveform.•Check dynamic flush after zeroing any pressure tubing system

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• POTENTIAL COMPLICATIONS 1. Dysrhythmias

2. Infection 3. Pneumothorax4. Pulmonary infarction 5. Balloon rupture and air embolism6. Pulmonary artery rupture

7. Endocarditis

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• ARTERIAL PRESSURE MONITORING: 1. Indications 2. Assessment data: * MAP = (diastolic x 2)+(systolic)

* MAP - ICP = CPP

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• ARTERIAL PRESSURE MONITORING:3. Arterial Waveform a. Aortic valve opens and blood is ejected

from LV and is recorded as an increase in pressure

b. Highest point represents systole

c. Lowest point is diastolic pressure

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• ARTERIAL PRESSURE MONITORING:• 4. Nursing Responsibilities• 5. Potential Complications: a. Thrombosis at catheter tip

b. Infection c. Bleeding d. Loss of flow distal to extremity

Nursing Responsibilities

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• Prepare the setup and the circuits• Assist in the procedure • Caring for equipments as well as for the

patient.• Calibration• Obtaining the readings• Interpreting the results and informing the

physician• Providing the suitable management• Documenting

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Swan Ganz Cathetarization

PROCEDURE FOR SETTING UP A HOMODYNAMIC CIRCUIT

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• Equipment Required: 1. 2 single transducer kit 2. 2 Pressure bags

3. 2 500 mL bag of .9 NaCl with1,000 units of

heparin 4. 2 transducer clamp 5. 2 pressure cable connected to Protocol

monitor

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PA Catheter Ppt

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