”) Marquette s4 electronics BASIC HEMODYNAMICS SELF-STUDY PROGRAMINTRODUCTION: Welcome to the Marquette Sales Training Self-study Series. This program was designed to give you a firm foundation in the theory and application of hemodynamic monitoring technology. The Basic Hemodynamics program will show you how monitoring technology measures blood pressure within the circulatory system. And how hemodynamic monitoring technology is used by health care professionals. This is the first in a series of modules. Subsequent modules will build on the material presented here. Therefore, it is important that you understand this material before moving on. HOW TO USE THE SELF STUDY PROGRAM: The Hemodynamics program consists of a series of modules. You should successfully complete this Module before moving on to Module Two. Follow these steps in completing this module: 1- Read the overview for each section. 2. As you complete each section, assess your progress using the "Spot Check", and repeat the part(s) of the lesson you did not do well in. 3. Once you have completed every section, test yourself using the "Self Assessment", and review the part(s) of the module you need to improve. This Module can be completed in less than one hour. BASIC HEMODYNAMICS: MODULE ONE PAGE 2LEARNING OBJECTIVES: The Overall and Specific Objectives identify key concepts and skills. They describe what you should know or be able to do after completing this module. For this module the Overall Objective i: The student demonstrates a basic understanding of the structure and function of the heart as an electro-mechanical system. We measure your achievement of this Overall Objective by your ability to: 1. Identify the anatomical location of the atria and ventricles. 2. Identify the name and anatomical location of the heart valves. 3. Identify blood flow through the heart and circulatory system. 4. Describe the role of the pulmonary and systemic circulatory systems. Describe the role of the arterial and venous - sides of the circulatory system. BASIC HEMODYNAMICS: MODULE ONE PAGE 3Overview: Function and Structure of the Heart The heart has only one function: to pump blood, With every beat, the heart pushes life-sustaining blood to every part of the body. Blood leaving the heart supplies the body tissues with vital oxygen and nutrients. Blood returning to the heart carries carbon dioxide and waste products for filtering and excretion by the lungs, kidneys, and liver. The heart is an electro-mechanical system. "Electro" means that the heart is controlled by electrical impulses. "Mechanical" refers to the heart's mechanical pumping action. ELECTRO - MECHANICAL SYSTEM The electrical system of the heart controls heart activity. The pacemaker, normally the SA Node, controls the heart rate - how often the heart beats. While the intra-cardiac conduction system controls the sequence and timing of heart contraction. BASIC HEMODYNAMICS: MODULE ONE PRGE &The heart and circulatory system operate on axather simple physical principle: ids flow from areas o: essure to areas of low pressure. By creating areas of high and low pressure the body makes blood (a fluid) flow. When the heart beats, an area of high pressure is created in the ventricle. At the same time, the pressure in the veins is relatively low. Therefore, blood will flow from the heart to the veins. BASIC HEMODYNAMICS: MODULE ONE PAGE 5The heart is actually two pumps in one; a right heart and a left heart. Each consisting of an atria and ventricle separated by a one way valve. Each side also has a one-way valve between the ventricle and major artery that conducts blood away from the ventricle. Right + Left THE HEART IS 2 PUMPS IN ONE BASIC HEMODYNAMICS: MODULE ONE. PAGE 6The right heart takes unoxveenated blood from the body and pumps it through the lungs. The right side of the heart and its' related blood vessels make up the pulmonary circulation. The left heart takes oxygenated blood from the lungs and pumps it through the body. The left side of the heart and its’ related blood vessels make up the systemic circulation. To Lungs THE CIRCULATORY SYSTEM BASIC HEMODYNAMICS: MODULE ONE PAGE 7There are two "sides" to the Circulatory system, The arterial and venous side of the circulatory system refers to the direction of blood flow in relation to the heart. Arterial blood flows awav from the heart, towards a capillary bed. As blood leaves the heart it flows through the arterial side of the circulatory system. The arterial side is made up of arteries, arterioles, and the proximal (near) portion of the capillaries. BASIC HEMODYNAMICS: MODULE ONE PAGE 8As blood leaves the arterial side of the circulatory system, it enters the Yenous side. On the venous side, blood flows toward the heart from a capillary bed. The venous side of the circulatory system is made up of the distal (far) portion of the capillaries, veins. and venules. BASIC HEMODYNAMICS: MODULE ONE PAGE 9Spot Check #1 Assess your understanding of the material presented in this module. 1 ‘The heart is an - system. 2 Blood flows from pressure areas to pressure areas. 3. ‘The systemic circulation pumps blood to the . 4 The pulmonary circulation pumps blood to the : 5 The arterial side of the circulatory system is made up of and . 6 The venous side of the circulatory system is .. made upof and BASIC HEMODYNAMICS: MODULE ONE. PAGE 10Overview: Blood Plow Through The Heart and Circulatory System As blood flows through the heart, it passes through different structures in a predictable sequence. In total, the sequence of blood flow represents both the pulmonary and systemic circulatory systems. Tracing blood flow through the normal heart we begin at the Right Atrium. While the heart is at rest (diastole), blood flows from the Vena Cava through the Right Atrium, Tricuspid Valve, and into the Right Ventricle. Only when the Right Ventricle is full of blood does the Right Atrium fill. RIGHT ATRIUM BASIC HEMODYNAMICS: MODULE ONE PAGE 11With contraction (systole), the walls of the Right Atrium push blood through the open Tricuspid Valve into the Right Ventricle. The Tricuspid Valve maintains one-way flow, meaning that blood can flow from the Right Atrium to the Right Ventricle, but not the reverse. As the Right Ventricle contracts, the Tricuspid Valve closes, preventing the back-flow of blood into the atrium. wu, TRICUSPID VALVE BASIC HEMODYNAMICS: MODULE ONE. PAGE 12As the Right Ventricle contracts, pressure is exerted against the blood. The pressure exerted by the right ventricle must be great enough to push blood through the arteries, arterioles, capillaries, venules, and veins of the pulmonary circulatory system. RIGHT VENTRICLE BASIC HEMODYNAMICS: MODULE ONE PAGE 13Normally, blood leaves the Right. Ventricle through the Pulmonic Valve. Like other valves in the heart, the Pulmenic Valve is a one-way valve. It allows blood to flow from the Right Ventricle to the Pulmonary Artery, but not the reverse. we, PULMONIC VALVE BASIC HEMODYNAMICS: MODULE ONE PAGE 14Once blood passes through the Pulmonic Valve it enters the Arterial Side of the Pulmonary Cir ion, Here, unoxygenated blood flows through the Pulmonary Arterv, Pulmonary Arterioles, and into the Pulmonary Capillary Bed. It is in tho Pulmonary Capillary Bed that carbon dioxide is released and oxygen is absorbed. BASIC HEMODYNAMICS: MODULE ONE PAGE 15The freshly-oxygenated blood now enters the Venous Side of the Pulmonary Circulation. As blood leaves the Pulmonary Capiliery Bed in the lung, it is collected in Pulmonary Venules, eventually flowing into the Pulmonary Vein as it returns to the heart. As blood leaves the pulmonary vein, it also leaves the pulmonary circulatory system. BASIC HEMODYNAMICS: MODULE ONE PAGE 16Blood enters the Systemic Circulation at the Left Atrium. Like the Right Atrium, when the heart is at rest. blood flows through the Left Atrium and Mitral Valve into the Left Ventricle. Only when the ventricle is full, does the atrium fill. During contraction, blood is pumped from the Left Atrium through the Mitral Valve and into the Left Ventricle. LEFT ATRIUM BASIC HEMODYNAMICS: MODULE ONE PAGE 17Blood flowing from the Left Atrium to the Left Ventricle flows through the Mitral Valve. The Mitral Valve, like other valves in the heart, maintains one-way blood flow. The Mitral Valve allows blood to flow from the Left Atrium to the Left Ventricle, not the reverse. we, MITRAL VALVE BASIC HEMODYNAMICS: MODULE ONE PAGE 18The Left Ventricle is the major pumping chamber of the heart. Its' role is to pump oxygenated blood through the Systemic Circulatory System. The pressure exerted by the Left Ventricle must be great enough to push blood through the arte: capillaries, venules, and veins of the s, arterioles, systemic circulatory system. LEFT VENTRICLE BASIC HEMODYNAMICS: MODULE ONE. PAGE 19As the Left Ventricle contracts, the Mitral Valve closes, allowing blood to flow only through the Rortic Valve. The Rortic Valve is the gateway to the Systemic Circulatory System. we, AORTIC VALVE BASIC HEMODYNAMICS: MODULE ONE PAGE 20Blood leaving the left side of the heart enters the Arterial Side of the Svstemic Cireulation. The arterial side delivers oxygenated blood to the tissues of the body. Blood leaving the Rertic Valve flows through the Berta (the main artery of the body), Arterioles, and Capillaries. In the capillaries, oxygen is released inte the body and carbon dioxide is absorbed for transport to the lungs. BASIC HEMODYNANICS: MODULE ONE PAGE 21Once the oxygen, carbon dioxide exchange has occurred, blood flows into the Venous Side of the Svstemic Circulation. Blood leaves the Capillary, and is collected in Venvles. and eventually Veins. Veins return the blood to the Superior and Inferior Vena Cava. Where our circuit is complete. BASIC HEMODYNAMICS: MODULE ONE PAGE 22Spot Check #2 Assess your understanding of the material presented in this module. Place the in order, Hye e me ao oo PELE L TET tte sequence of blood flow through the heart beginning with the Right Atrium. Right Atrium Left Atrium Arterial Side, Systemic Circulation Pulmonic Valve Venous Side, Pulmonary Circulation Right Ventricle Tricuspid Valve Left Ventricle Rortic Valve Arterial Side, Pulmonary Circulation venous Side, Systemic Circulation Mitral Valve BASIC HEMODYNAMICS: MODULE ONE PAGE 23SELF ASSESSMENT The Self Assessment allows you to test your knowledge of the subject matter presented in this Module. Use this test to identify your strengths and weaknesses and guide further study. 1. The pulmonary circulation takes blood from the and pumps it through the . 2. The systemic circulation takes blood from the and pumps it through the 3. The four valves of the heart are: 4. The four chambers of the heart are: BASIC HEMODYNAMICS: MODULE ONE. PRGE 24pot Check and S: sessm sue! Spot Check #1 1. Electro - Mechanical 2. High, Low 3. Oxygenated, Tissues of the body 4. Unoxygenated, Lungs $. Arteries, Arterioles, Proximal Capillary 6. Distal Capillary, Venules. Veins Spot Check #2 1 oak bo7 e at a4 e 6 £ 3 2 2 h 9 i 20 38 k 12 1 8 Self-Assessment 1, Right Heart, Lungs 2. Left Heart, Body 3. Tricuspid Valve Pulmonic Valve Mitral Valve Rortic Valve 4. Right Atrium Right Ventricle Left Atrium Left Ventricle BASIC HEMODYNAMICS: MODULE ONE PAGE 25BASIC HEMODYNAMICS SELF-STUDY PROGRAM MODULE TWO: Introduction to Blood Pressure This Module provides you with a basic understanding of the effect pressure has on blood flow, and normal pressures present in different structures of the circulatory system.INTRODUCTION: Welcome to the Marquette Sales Training Self-Study Series. This program was designed to give you a firm foundation in the theory and application of hemodynamic monitoring technology. The Basic Hemodynamics program will show you how monitoring technology measures blood pressure within the circulatory system. And how hemodynamic monitoring technology is used by health care professionals. This is the second of a series of modules that make up the Basic Hemodynamics Self-Study Program. If you have not completed the material in Module One do so before you continue. HOW TO USE THE SELF STUDY PROGRAM: Follow these steps in completing this module: 1. Read the overview for each section. 2. As you complete each section, assess your progress using the "Spot Check", and repeat the part(s) of the lesson you did not do well in. 3. Once you have completed every section, test yourself using the "Self Assessment", and review the part(s) of the module you need to improve. This Module can be completed in less than one hour. BASIC HEMODYNAMICS: MODULE TWO PAGE 2LEARNING OBJECTIVES: The Overall and Specific Objectives identify key concepts and skills. They describe what you should know or be able to do after completing this module. For this module the Overall Objective is: The student demonstrates a basic understanding of how blood pressure influences blood flow. We measure your achievement of this Overall Objective by your ability to: 1. Define blood pressure. 2. Differentiate pulsatile and non-pulsatile blood pressures. 3. Identify normal blood pressure in different structures of the circulatory system. Identify the components of a normal arterial waveform. BASIC HEMODYNAMICS: MODULE TWO PRGE 3Qverview: Fundamentals of Blood Pressure In Module One you learned that the heart is an electro-mechanical system; that electrical impulses control the activity of the heart. You also learned that blood flows from areas of high pressure to areas of low pressure. And that within the circulatory system, blood flows through the structures of the heart in a predictable sequence. You also learned that there are two parallel circulatory systems: the Pulmonary Circulatory System and the Systemic Circulatory System. And you learned that each system has an Arterial and Venous Side. BASIC HEMODYNAMICS: MODULE TWO PAGE &Every one of the structures in the circulatory system is always filled with blood, The pressure exerted by blood against the walls of the circulatory system is called Blood Pressure. Blood pressure differs greatly throughout the circulatory system. The ventricles create areas of high blood pressure, while the veins have relatively low pressure. The result is blood flowing from areas of high to low pressure. Bi (We 8legd= BLOOD PRESSURE BASIC HEMODYNAMICS: MODULE TWO PAGE 5Blood pressure is measured in millimeters of mercury (mmHz). This unit of measure dates back to the time when practitioners used a mercury manometer to measure blood pressure. Many practitioners still use mercury manometers today. You will also see mercury manometers in use when blood pressure devices are calibrated. The mercury manometer is the "gold standard" against which all blood pressure measuring devices are compared. BASIC HEMODYNAMICS: MODULE TwO PAGE 6There are a number of factors that influence blood pressure. The first is the Amount of Blood in the steucture. The general rule is that the greater the amount of blood in the structure; the greater the blood pressure. The second factor is the Volume of the Structure. In other words, how much blood will the structure hold. Generally the greater the volume; the lower the pressure. The third factor is the amount of pressure exerted by the structure. The heart and arterioles have the ability to exert pressure on the blood by contracting or constricting. When the heart or arterioles contract or ce constrict, the volume of the structure is reduced while the amount of blood stays the same. Therefore, the blood pressure will increase. Similarly, when the heart or arterioles xelax, the volume of the structure will increase while the amount of blood stays the same. And the blood pressure will decrease. BASIC HEMODYNAMICS: MODULE TWO PRGE 7Because blood is a liquid, it is relatively non-compressible; meaning that whatever pressure is exerted against blood, that pressure will be directly transmitted to the structures surrounding it. Therefore, when the heart contracts, the strength of the contraction is directly transmitted to the structures of the arterial side of the circulatory system. BASIC HEMODYNAMICS: MODULE Two PAGE 8Spot Check #1 Assess your understanding of the material presented in this module. 1 ‘Three factors that influence blood pressure are . ' and . 2 When the heart contracts, blood pressure 3 When the arterioles relax, blood pressure 4 Because blood is non-compressible, the force of ventricular contraction is directly transmitted to the BASIC HEMODYNAMICS: MODULE Two PRGE 9Overview: Pulsatile and Non-Pulsatile Blood Pressures Because the heart alternates between contraction and relaxing, the blood pressure in the heart and on the arterial side will alternate between high and low. A blood pressure that alternates between high and low is known as a Pulsatile Blood Pressure. There are three major components of a pulsatile blood pressure; a high reading, a low xeading, and an average reading. BASIC HEMODYNAMICS: MODULE Two PAGE 10The high reading is known as the Svstolic Blood Pressure. The systolic blood pressure is the maximum pressure exerted by contraction of the heart. Systolic blood pressure is measured at the peak of ventricular contraction (systole). The low reading is known as the Diastolic Blood Pressure. The diastolic blood pressure occurs when the heart is at rest. Diastolic blood pressure is the minimum pressure inside the heart and arteries, measured during diastole, immediately before the ventricles contract. The third reading, measuring the averase blood pressure in the artery, is the Mean Arteria] Blood Pressure (MAP). MAP is the average pressure in the “- artery over time. BASIC HEMODYNAMICS: MODULE TWOé Because the heart is at rest more often that it is contracting, the average blood pressure is found about one-third of the difference from the diastolic to the systolic blood pressure. An easy way to calculate an estimate of the mean arterial blood pressure is by using this formula: 1/3 (Systolic-Diastolic) + Diastolic BRSIC HEMODYNAMICS: MODULE TWOWhen blood flows through the capillaries, it looses its’ pulsatile quality. Therefore pressures on the venous side are referred to as Non- Pulsatile Blood Pressures. Because there are no wide fluctuations in the pressure inside the veins, the venous pressure has only one component, the Venous Pressure. If we were to measure and graph the blood pressure on the venous side of the circulatory system, we would create a waveform with no major fluctuations. BASIC HEMODYNAMICS: MODULE TWOSpot Check #2 Assess your understanding of the material presented in this module. a A blood pressure that alternates between systolic and diastolic values is a blood pressure. A blood pressure that remains relatively constant is a blood pressure. The three components of a pulsatile blood pressure are : y and . The estimated MAP of a systolic blood pressure of 120 mmHg and a diastolic blood pressure of 90 mmHg is . BASIC HEMODYKAMICS: MODULE TwoQVERVIEW: Normal Blood Pressure Values Blood Pressure is present in every structure of the circulatory system. And, theoretically, blood pressure can be measured at any point in the system. By placing a tube called a catheter within a structure, and connecting it to a monitoring system, blood pressure can be measured directly. Within the heart, pulsatile blood pressure measurements are: Right Atrium 6/2 ight Ventricle Buse Left Atrium 1276 Left Ventricle 130/6 wu, BLOOD PRESSURE WITHIN THE HEART BASIC HEMODYNAMICSOn the arterial side of the Systemic and Pulmonary Circulatory Systems, the normal, pulsatile, blood pressures are: Pulmonary Artery Pressure 34/15 Rortic (ART) Blood Pressure 120/80 And on the venous side of the circulatory system, normal, non- pulsatile, blood pressures include: Central Venous Pressure 2 Pulmonary Artery Wedge (PAW) 10 eM PA ART ¢ PAW | cvP ELOOD PRESSURE IN THE CIRCULATORY SYSTEM BRSIC HEMODYNAMICS: MODULE Two chee aeSpot Check £3 . Assess your understanding of the material presented in this module. 1 The normal blood pressure in the Left Ventricle is approximately . 2 ‘The normal Arterial (Aortic) blood pressure is approximately . 3 ‘The normal Pulmonary Artery Wedge Pressure is approximately BASIC HEMODYNAMICS: MODULE TWO.Overview: The Arterial Blood Pressure Waveform The arterial blood pressure waveform represents a number of different events. It is used by the clinician in evaluating the hemodynamic status of patients. The "X" or horizontal axis of the arterial pressure waveform measures duration or time. Usually, arterial pressure waveforms are graphed at 25 mm/sec. The "Y" or vertical axis measures strength or amount of pressure. The height of the waveform is dependant on "scale" on which the waveform is graphed. The smaller the scale; the larger the waveform. "R" AND "Y" AKIS BASIC HEMODYNAMICS: MODULE TWOThree main events can be seen on the arterial blood pressure waveform. The first is Ventricular Svstole. Ventricular systole begins with a rapid rise in pressure, and ends at the vesk of the waveform. The peek of the waveform represents arterial systolic pressure. ARTERIAL SYSTOLIC PRESSURE © HEMODYNAMICS: MODULE TWO.The second is Aortic Valve Closure. Rortic valve closure occurs immediately after systole, as blood begins to flow back into the heart. The Dicrotic Notch indicates aortic valve closure. 120. Pm hearic Vawe am PUG, ‘ AORTIC VALVE CLOSURE BASIC HEMODYNAMIC: MODULE TWOThe third event represented by the arterial waveform is Ventricular Diastole. The lowest point on the waveform, immediately before systole, is the arterial diastolic pressur VENTRICULAR DIASTOLE ERSIC HEMODYNAMICS: MODULE TWoSpot Check #2 Assess your understanding of the material presented in this module. 1 ‘The "KX" axis of the pressure waveform represents . 2. The "Y" axis of the pressure waveform represents 3 _ Identify the portion of the waveform that represents 1 Ventricular Systole, 2 Ventricular Diastole, and 3 Aortic Valve Closure. EASIC HEMODYNAMICS: MODULE TWOSELF ASSESSMENT The Self Assessment allows you to test your knowledge of the subject matter presented in this Module. Use this test to identify your strengths and weaknesses and guide further study. 1. Pulsatile blood pressures are made up of ' and The "Y" or vertical axis of a pressure waveform measures . The "X" or horizontal axis of a pressure waveform measures : Pulsatile pressures are found on the side; while non-pulsatile pressures are found on the side. Identify the portion of the waveform that represents 1 Ventricular Systole, 2 Ventricular Diastole, and 3 Aortic Valve Closure. PReTC YEMODYNAMTOS: MODULE TWOSpot Check and Self Assessment Answers Spot Check #1 1. Amount of Blood, Volume of Structure, Contraction/Constriction 2. Increases 3. Decreases oe Arterial Side Spot Check #2 1. Pulsatile blood pressure 21 Non-Pulsatile blood pressure 3. Systolic, Diastolic, Mean &. 100 mmHg Spot Check #3 1. 1130/6 mmHg 2. 120/80 mrHg 3. 10 mmHg Spot Check #4 1. Time (duration) 2. Amount (strength) 3. ' 3 2 Self-Assessment 1. Systolic Blood Pressure, Diastolic Blood Pressure, Mean Blood Pressure 2. Strength (amount of pressure) 3. Duration (length of time) 4. Arterial, Venous 5. | 3 2 BASIC HEMODYNAMICS: MODULE TWO caeBASIC HEMODYNAMICS SELF-STUDY PROGRAM ODULE THREE: Direct Pressure Monitoring. This module provides the student with a basic understanding of direct (invasive). blood pressure monitoring.INTRODUCTION: Welcome to the Marquette Sales Training Self-Study Series. This program was designed to give you a fixm foundation in the theory and application of hemodynamic monitoring technology. The Basic Hemodynamics program will show you how monitoring technology measures blood pressure within the circulatory system. And how hemodynamic monitoring technology is used by health care professionals. This is the third in a series of modules. If you have not completed the material in Modules One and Two, do so before you continue. HOW TO USE THE SELF STUDY PROGRAM: Follow these steps in completing this module: 1. Read the overview for each section. 2. As you complete each section, assess your progress using the "Spot Check", and repeat the part(s) of the lesson you did not do well . in 3. Once you have completed every section, test yourself using the "Self Assessment". and review the part(s) of the module you need to improve. This Module can be completed in less than one hour. BASIC HEMODYNAMICS: MODULE THREE FAGE 2LEARNING OBJECTIVE: The Overall and Specific Objectives identify key concepts and skills. They describe what you should know or be able to do after completing this module. For this module the Overall Objective is: The student demonstrates a basic understanding of direct blood pressure measurement. We measure your achievement of this Overall Objective by your ability to: 1. Describe the basic concepts supporting direct (invasive) blood pressure measurement. Identify the components of a direct (invasive) blood pressure monitoring setup. 3. Identify the pressures commonly measured directly in the clinical environment. BASIC HEMODYNAMICS: MODULE THREE PRGE 3Qverview: Concepts in Direct Pressure Measurement Direct blood pressure measurement involves placing a sensor (measuring device) directiv in the circulatory system, and measuring the pressure. Because one is invading the body, direct blood pressure measurement is often referred to as invasive pressure measurement. Invasive blood pressure measurement is favored for a number of reasons. First, the practitioner can measure the pressure in a specific location. This allows the practitioner to measure the - function or performance within the heart and circulatory system. Second, when done properly, invasive - pressure measurement is the most accurate method for measuring blood pressure. BASIC HEMODYNAMICS: MODULE THREE PAGE &Direct blood pressure measurement invelves placing a small-diameter tube, called a catheter, in the circulatory system. The catheter, and attached tubing, are filled with water. As you remember from an earlier Module, water is relatively non-compressible. Therefore, the pressure at the opening of the catheter will be the same as the pressure at the end of the tubing. The end of the tubing is connected to a transducer. The transducer is a device that transforms mechanical energy (pressure) into electrical enerey (signal). Because of the water inside the catheter and tubing, the blood pressure is directly transmitted to the transducer. CATHETER, TUBING, AND TRANSDUCER BASIC HEMODYNAMICS: MODULE THREE PAGE 5Once the, pressure has been changed to an electrical signal, the invasive pressure monitor transforms the electrical enerey to two data types, waveform and numeric data. Waveform data is a graphic representation of the blood pressure over time. While numeric data is a digital reading of specific blood pressure measurements. For pulsatile blood pressures numeric data include systolic, diastolic, and mean blood pressures. RE AES 1207 60/214 (94)| | 7 WAVEFORM AND NUMERIC DATA BASIC HEMODYNAMICS: MODULE THREE PAGE 6ot Check #1 Assess your understanding of the material presented in this module. 1 Two reasons direct (invasive) pressure monitoring is preferred are: 2 The pressure inside the circulatory system is directly transmitted because the fluid in the tubing is not : 3. A device that converts mechanical to electrical energy is called a 4 ‘Two data types displayed on an blood pressure monitor are and data. BASIC HEMODYNAMICS: MODULE THREE PAGE 7Overview: Invasive Pressure Sites Earlier in this Module you learned how an invasive pressure monitor works. With minor differences in the way the software processes the signal, all invasive pressure monitors work the same. The differences appear in where the catheter (sensor) is located, In an earlier module, you learned that different structures in the heart and circulatory system have different normal blood pressures. By placing a catheter in each structure the practitioner can measure the pressure and make decisions regarding the relative health of the structure. “ee 120 80 6 130 4 6 4 DIFFERENT SITES - DIFFERENT PRESSURES BRSIC HEMODYNAMICS: MODULE THREEAlthough it is possible to measure blood pressure at almost any location within the heart and circulatory system, certain sites are routinely measured. The Arterial (ART) Blood Pressure is probably the blood pressure most often measured. The arterial pressure is a pulsatile pressure. The ART line provides the practitioner with information regarding the strength of left ventricular contractions and the condition of the arteries. It is roughly equal to the pressure in the aN Aorta. ARTERIAL BLOOD PRESSURE BASIC HEMODYNAMICS: MODULE THREE PAGE 9The Pulmonary Artery (PA) Pressure is the equivalent of the Arterial Blood Pressure for the pulmonary circulatory system. Like the ART line, the PA pressure is pulsatile in nature. PA pressure provides information regarding the effectiveness of right ventricular contraction, and the condition of the arteries in the lungs. PA pressure is measured using a Swan- Ganz catheter. PULMONARY ARTERY PRESSURE BASIC HEMODYNAMICS: MODULE THREE PAGE 10BASIC HEMODYNAMICS: The Swan-Ganz catheter can also be used to measure the Pulmonary Artery Wedge {PBW) pressure. Also known as the Pulmonary Artery Occlusive pressure, the PAW measures the amount (pressure) of blood being supplied to the Left Atrium or "Preload To measure PAW, a small balloon on the end of the Swan-Ganz catheter is inflated. The balloon floats downstream until it becomes lodged, or wedged, in a pulmonary artery. The measurement opening of the catheter is distal to, or past the balloon. By inflating and wedging the balloon, the pressure in the pulmonary artery is blocked from influencing the measurement opening. Therefore, the pressure at the opening is equal to that of the pressure on the venous side of the capillary bed. PAW PRESSURE MODULE THREEThe Ce: us Pre: OVP) is another venous blood pressure frequently measured. The CVP provides the practitioner with a rough estimate of how much blood is returning to the heart. CENTRAL VENOUS PRESSURE BASIC HEMODYNAMICS: MODULE THREE PGE 42Invasive pressure measurement can also be performed in areas other than the circulatory system, One common non- circulatory invasive pressure measurement is Intra-cranial Pressure (cp). ICP measures the pressure exerted by the brain and its' coverings. Because the volume of the skull does not change, any change in ICP is due to an increase or decrease in the contents of the skull. Any swelling of the brain or pleeding inside the skull will increase the IcP. A value calculated from the ICP measurement is the Cerebral Perfusion Pressure (CPP). CPP is calculated by the following formula: MAP - IcP = CPP INTRA-CRANIAL PRESSURE BASIC HEMODYNAMICS: MODULE THREESpot. Check #2 Assess your understanding of the material presented in this module. The Arterial Blood Pressure measurement is roughly equal to the pressure in the The Pulmonary Artery and Pulmonary Artery Wedge Pressures are measured using a The Pulmonary Artery Wedge measurement is also known as - The measures the amount of blood returning to the heart. The formula for calculating Cerebral Perfusion Pressure is . BASIC HEMODYNAMICS: MODULE THREE. PLGE 14SELF ASSESSMENT The Self Assessment allows you to test your knowledge of the subject matter presented in this Module. Use this test to identify your strengths and weaknesses and guide further study. 1. Direct (invasive) pressure measurement is more / less accurate than other methods. 2. The most common invasive pressure measurement is . 3. The Swan-Ganz Catheter is used to measure and 4. The direct pressure measurement that closely correlates to preload is 5. Identify the invasive pressure site names for ++ the following pressures. is © 6D BRSIC HEMODYNAMICS: MODULE THREESpot Check and Self Assessment ers Spot Check #1 1, Measure at a specific location Most accurate method a Compressible 3 Transducer 4 Waveform, Numeric Spot Check #2 1, Aorta 2. Swan-Ganz Catheter 3. Preload 4, Central Venous Pressure (CVP) 5, MAP - ICP = CPP Self-Assessment 1. More 2, Arterial Blood Pressure (ART) 3. Pulmonary Artery Blood Pressure (PA) Pulmonary Artery Wedge Pressure (PAW) 4. Pulmonary Artery Wedge Pressure (PAW) 5. oa, PA b. PAW c. Ove ad. ICPvopP BASIC HEMODYNAMICS: MODULE THREE PAGE 16BASIC HEMODYNAMICS SELF-STUDY PROGRAM MODULE FOUR: Indirect Pressure Monitoring. This module provides the student with a basic understanding of indirect (non-invasive) blood pressure monitoring.INTRODUCTION: Welcome to the Marquette Sales Training Self-Study Series. This program was designed to give you a fixm foundation in the theory and application of hemodynamic monitoring technology. The Basic Hemodynamics program will show you how monitoring technology measures blood pressure within the circulatory system. And how hemodynamic monitoring technology is used by health care professionals. This is the last in a series of modules. If you have not completed the material in the each of the first three Modules, do so before you continue. HOW TO USE THE SELF STUDY PROGRAM: Follow these steps in completing this module: 1. Read the overview for each section. 2. Bs you complete each section, assess your progress using the "Spot Check", and repeat the part(s) of the lesson you did not do well in. Once you have completed every section, test yourself using the review the part(s) of the module you need to elf Assessment", and improve. This Module can be completed in less than one hour. BASIC HEMODYNAMICS: MODULE FOUR PAGE 2LEARNING OBJECTIVES: The Overall and Specific Objectives identify key concepts and skills. They describe what you should know or be able to do after completing this module. For this module the Overall Objective is: The student demonstrates a basic understanding of indirect (non-invasive) blood pressure measurement. We measure your achievement of this Overall Objective by your ability to: 1. Describe the physical events that make indirect (non-invasive) blood pressure measurement possible. 2, Identify the components of a indirect (non- invasive) blood pressure monitoring setup. 3. Describe the basic concepts supporting auscultatory blood pressure technology. ae Deseribe the basic concepts supporting oscillometric blood pressure measurement. BASIC HEMODYN AMICS: MODULE FOUROverview: Concepts in Indirect Pressure Measurement BASIC HEMODYNAMICS: Indirect blood pressure measurement involves using a pressurized cuff to measure blood pressure. Because this is able to be done without entering the body, indirect blood pressure measurement is often referred to as non= invasive blood pressure measurement (NBP) . NBP measurement is sometime preferred for a number of reasons. First, NSP measurement is convenient and easy to perform. This allows the practitioner to obtain a blood pressure measurement in a moments! notice, without much effort. Second, the NEP setup is simple. NBP measurement can be performed without elaborate equipment. Third, NBP is relatively safe. Because NBP measurement does not require an invasive procedure, the risk of complications is almost nonexistent. Finally, when done properly, NEP can provide accurate blood pressure measurements. MODULE FOURNBP Measurement also has drawbacks. First, NBP technology is limited to arterial blood pressure measurement. Second, because the technique requires applying an inflatable cuff to a limb, NEP can be uncomfortable. Finally, because sound or vibration are the basis of NBP technology, readings are very susceptible to interference. BASIC HEMODYNAMICS: MODULE FOUR sane ecpot Cl Ha Assess your understanding of the material presented in this module. 1 Four advantages of NBP measurement include: 2 Two disadvantages of NBP measurement include: BASIC HEMODYNAMICS: MODULE FOUR PACE &Overview: NBP Measurement Every NBP technology is designed to identify the same phenomenon. The walls of the arteries are flexible and would collapse if not for the pressure of the blood inside the artery. Pressure keeps the artery inflated and open constantly. When a cuff is applied over the artery and inflated to a pressure greater than the pressure inside the artery, the artery walls collapse, and no blood flows through the artery. As the cuff is deflated, the pressure inside the artery will exceed that in the cuff. When this occurs, blood flow will resume. i Because arterial blood pressure is pulsatile in nature, the artery will alternate between being open and closed when the cuff pressure is between the systolic and diastolic blood pressure. BASIC HEMODYNAMICS: MODULE FOURWhen the pressure in the artery exceeds the cuff pressure, the artery opens and blood flows. When the pressure in the artery falls below the cuff pressure, the artery closes. The starting and stopping of blood flow causes the walls of the artery to vibrate, and makes the flow of blood turbulent. ARTERIAL PRESSURE / OPEN OR CLOSED BASIC HEMODYNAMICS: MODULE FOURThe vibration and noise produced by the starting and stopping of blood flow are the basis for NBP measurement. When performing NBP measurement, no vibration or sound will be observed until the cuff pressure is equal to the systolic blood pressure. At that point, the artery will briefly open and allow a small amount of blood to pass. I€ we know the pressure inside the cuff when we first observe sound or vibration, we know the systolic blood bE mre. See KJ. CUFF PRESSURE = SYSTOUIC PRESSURE SYSTOLIC BLOOD PRESSURE BASIC HEMODYNAMICS: MODULE FOURSimilarly, when the pressure in the artery is always greater than the pressure in the cuff, the artery will always remain open. Therefore the sound or vibration produced by the opening and closing of the artery will cease. If we know the pressure inside the cuff when sound or vibration stops, we know the diastolic blood pressure. curr iy DIASTOLIC BLOOD PRESSURE BASIC HEMODYNAMICS: MODULE FOURpot. Assess yor ur understanding of the material presented in this module. 1 The walls of the arteries are kept open by —_—— When the pressure inside the NBP Cuff is greater than the blood pressure, the artery _ he starting and stopping of blood flow and creates ————____——"Overview: Auscultatory NBP Measurement Earlier in this Module you learned that as the pressure in the artery exceeds the pressure in the cuff, the opening and closing of the artery produces sound. These sounds are known as Karotkoff Sounds. By listening to the sound produced by the opening and closing of the artery, and knowing the pressure inside the cuff, you can identify the systolic and diastolic arterial blood pressure. BASIC HEMODYNAMICS: MODULE FOUR PAGE i2The method of measuring NBP using sound is called the Auscultatory method. You are probably familiar with the auscultatory method from the last time you had your blood pressure checked. During that exam, the person measuring your pressure watched a pressure gauge while listening to the artery in your arm. Ruscultatory NBP technique allows the practitioner to observe the systolic blood pressure, and the diastolie blood pressure. The mean blood pressure is calculated on the basis of these values. MAP = 1/3 (SYS-DIA) + DIA BASIC HEMODYNAMICS: MODULE FOURSpot Check #3 Assess your understanding of the material presented in this module. 1 The method of NBP measurement that uses sound is known as . Sounds produced by the opening and closing of the artery are called . By listening, the practitioner can observe and pressures and calculate pressure. BASIC HEMODYNSMICS: MODULE FOUR, SACRE 44Qverview: Oscillometric NBP Measurement Earlier in this Module you learned how sound is used to measure the pressure in the artery. You also learned that as the opening and closing of the artery causes the artery wall to vibrate. Because the artery opens and closes in a predictable fashion, the artery walls will "oscillate" as the cuff is deflated. By observing the oscillation of the artery wall, and knowing the pressure inside the cuff, you can measure blood pressure. BASIC HEMODYNAMICS: MODULE FOURThe method of measuring NEP using oscillation of the arterial wall is called the Qscillometric method You are most likely familiar with the oscillometric method because most automatic NEP machines use this method. BASIC HEMODYNAMICS: MODULE FOUR Daae aeThe Oscillometric method allows the practitioner to observe the svstolic blood pressure, diastolic blood pressure, and the mean arterial blood pressure. This is done by observing the amplitude of the oscillations. The appearance and disappearance of oscillations correspond to the Systolic and Diastolic pressures respectively. While greatest amplitude of oscillation is equal to the Mean pressure. SYSTOLIC - MEAN - DIASTOLIC OSCILLATIONS BASIC HEMODYNAMICS: MODULE FOURSpot Check #4 Assess your understanding of the material presented in this module. 1 ‘The method that uses vibration to measure blood pressure is known as 2 By measuring arterial vibration the practitioner can observe and blood pressures. 3 The oscillation with the greatest amplitude is equal to the . BASIC HEMODYNAMICS: MODULE FOURSELF ASSESSMENT The Self Assessment allows you to test your knowledge of the subject matter presented in this Module. Use this test to identify your strengths and weaknesses and guide further study. 1. The two methods commonly used for indirect (non-invasive) pressure measurement are and . 2. An advantage of NEP measurement is 3. A disadvantage of NBP measurement is 4. In NEP measurement, the appearance of the first sound or vibration is equal to 5. In NBP measurement, the disappearance of sound or vibration is equal to 6 The NBP method that allows the practitioner to observe the mean is : BASIC HEMODYNAMICS: MODULE FOURSpot Check and Self Assessment Answers. Spot Check #1 1. Convenient Easy to use-Simple Safe Accurate 2. Limited to Arterial Blood Pressure Uncomfortable Spot Check #2 1. Pressure 2. Artery collapses and blood flow stops 3. Noise, Vibration Spot Check #3 1. Auscultatory 2. Karotkoff sounds 3. Systolic and Diastolic, Mean Spot Check #¢ 1. Oscillometric 2. Systolic, Diastolic, Mean 3. Mean Arterial Blood’ Pressure Self-Assessment, 1. Oscillometric, Auscultatory 2. Simple, Easy to use, Safe, Convenient, Accurate 3 Uncomfortable, Susceptible to interference 4. Systolic blood pressure 5. Diastolic Blood Pressure 6. Oscillometric method BASIC HEMODYNAMICS: MODULE FOUR