Hemodynamic monitoring Flashcards
Blood Flow through the heart
RT Atrium
RT Ventricle
Lungs = oxygen
LT Atrium
LT ventricle
Body
Cardiac output
CO=SV X HR
4-8 Liters
Cardiac Index
BSA measurement
2.2-4 l/m/m2
cardiac output/BSA
MAP
70-105 mmHg
SBP +2(DBP)/3
Pulmonary Artery Diastolic Pressure (PAD)
4-12 mmHg
Elevated PAD caused by conditions that affect the left side of the heart
LT heart failure, MI
low PAD caused by inadequate venous return to the heart- low preload caused my shock or dehydration, sustained tachycardia
Pulmonary Artery Systolic Pressure (PAS)
18-25 mmHg
Elevated in conditions that increase Right ventricle afterload of PVR (pulmonary HTN, Lung disease, hypoxemia)
Right Atrial Pressure (RAP)
2-8 mmHg
directly measures right ventricle preload
fluid volume excess or processes that increase PVR, increase RAP
ex: HF, Pulmonary HTN, Cardiac tamponade
decrease in RAP is related to fluid loss r/t absolute burns or relative losses
Stroke Volume (SV)
60-150 ml/beat
Systemic Vascular Resistance (SVR)
800-1200
indirectly measures LT sided afterload
Left ventricular Afterload
the amount of resistance that the LT ventricle must overcome to pump blood out of the heart and body
elevated SVR can create a high myocardial oxygen demand and decrease SV and CO
Central Venous Pressure (CVP)
2-8 mmHg
indicator of central blood volume
in critical care sometimes increase CVP to deliver O2 to body
reflects RT heart preload and RAP, but does Not directly reflect anything on LT side since catheter lies outside of heart
complications associated with insertion of CVC
pneumothorax
hematoma
infection
minimally invasive
ART line
used to monitor BP
respiratory instability and respiratory insufficiency
advantages of ART line
minute to minute BP monitoring
increased accuracy of monitoring
Obtaining frequent ABG’s
disadvantages of ART line
Peripheral artery BP may not clearly indicate central BP
occlusion of vessels, can lead to ischemia and possible necrosis of tissue distal to insertion site
ART lines can be placed in the following areas
Radial Artery
Brachial Artery
Femoral Artery
Axillary Artery
Pulmonary Artery Catheters
Indicates health of heart, circulation, and lung health
inserted into neck or chest into RT atrium to RT ventricle and circles through Pulmonary Artery
Preload can be measured with this device
what is preload
the stretching occurring in the heart at the end of diastole when heart relaxes, r/t fluid left in heart
pulmonary artery wedge pressure
indirectly measures LT ventricle preload
not located inside the heart
insert balloon creates occlusion on systole, during diastole can feel if fluid is flowing backwards from LT ventricle
pulmonary vascular resistance (PVR)
directly measures RT sided afterload
is an estimate of Right ventricular afterload
absolute losses
burns
diuresis
hemorrhage
vomiting
these decrease RAP
relative losses
Shock
Vasodilation
Third Spacing
(fluid is NOT in vessel and non existent to CV system)
causes decrease in RAP
what is the best way to treat issues with RAP?
treat the underlying problem
increased RAP- restrict fluid, restrict sodium, diuretics (furosemide)Lasix’s
Decreased RAP- provide fluids (crystalloid), transfusions
Pulmonary Artery Pressure (PAP)
reflects both right and left heart pressures and is read like a BP (PAS)/(PAD)
normal 20-30/ 4-12
what makes a PAP inaccurate?
mitral stenosis
sustained tachycardia
COPD
PE
causes of elevated SVR
hypovolemia (in a healthy patient), cardiac failure
causes of decreased SVR
systemic vasodilation
medications
states of shock (sepsis)
