IABP = gold standard of BP measurement

EQUIPMENT:

Intra-arterial cannula:

- Short, narrow, stiff = so its resident frequency is outside harmonic range

- Teflon = reduce thrombus formation
- Narrow = risk of thrombus proportional to diameter (20-22g)

Fluid-Filled Tubing:

- Column of non-compressible fluid w no bubbles between arterial line and transducer for
Hydraulic Coupling
- Short, wide and stiff = reduce damping
- Short; <1.2m = reduce damping
o The fluid filled system has a ‘natural frequency’ of resonance
o NF is proportional to the length of tubing
o So longer tubing = lower natural frequency
o Patient’s pulse oscillation is low frequency so with longer tubing the NF approaches
the patient’s pulse frequency
o This will cause resonance and amplify the signal and the system will be under-
damped
- Stiff;
o Soft IV tubing will absorb the wave and damp the system
- Wide;
o Damping increases by the third power of any decrease in the diameter of tubing
o Ie narrow tubing increases damping

3 way tap:

- Allows zeroing and blood sampling

Pressure Transducer:

- Consists of a diaphragm and strain gauge

- Converts pressure waveform into electrical signal

Flush System:

- Pressurized saline at 300mmHg

- Allows slow infusion 2ml/hr to maintain patency
- Flushing allows us to check Damping, Natural Frequency, and keep tubing clear

Signal Processor Cable:

- Electrical signal derived from pressure transducer is transmitted via cable to microprocessor
for filtering, amplification, analysis and display on a screen as Pressure v Time wave
MoA

- Arterial pulsation moves saline column nack and forth

- Causes diaphragm to move
- This changes the resistance in the wires of the transducer
- One of these resistance wires is the resistor of a Wheatstone Bridge (the variable resistor
R3)
- The Wheatstone Bridge uses the null deflection system where R1/R2 = R3/R4
- A change in the resistor is measured and electronically converted into displayed arterial
pressures and waveforms

PHYSICS

SOURCES OF ERROR

ADV

- Continuous data
- Waveform analysis (ie contractility)
- Direct measurement of all blood pressures (SBP, MAP, DBP), HR
- Samples blood for ABG analysis and reduces venipuncture requirements

DISADV

- Clotting and backflow through cannula and line set if we lose pressurization
- Arterial damage, or in fact any tissue/nerve damage around the site of insertion
- Infection
- Ischaemia
- Inadvertant drug injection into artery
- Requires periodic check and zeroing to confirm accuracy
- Bleeding from inadvertent disconnection
- Waveform needs to be displayed to detect resonance and damping
- Requires calibration

CALIBRATION

Calibration is in 2 parts; Static & Dynamic

Static

- Manufacturer guarantees that as P increases = R increases in a linear fashion

- But bc we work at a different atmospheric P we need to calibrate it to Zero Atmosphere

Calibrating (‘zeroing’)
  Zeroing – the use of atmospheric pressure as a reference standard against which all other
pressures are measured
 ensure the transducer pressure tubing and flush solution are correctly assembled and free of
air bubbles
 place transducer at level of the right atrium
 ‘off to patient, open to air (atmosphere)’
 press ‘zero’ -> sets atmospheric pressure as zero reference point
 whenever patient position is altered the transducer height should be altered
 even though atmospheric pressure is constant
 the system is closed  the zero reference point & cannula tip need to be exactly the same
level to measure the pressure in the artery
 The Zero Reference Point is the level of the top of the fluid column (air fluid interface)
above/below the diaphragm when the tap is open to air
 The transducer is measuring the mean pressure in the artery (the height of the fluid column
above the zero point (which is 0mmHg when they were zeroed at the same level)
 If patient’s table is elecated above this level 20cm, the pressure recorded will be arterial
pressure + 20cm H2O due to the vertical height of the fluid column (divide by 1.36 to convert
cmH2O to mmHg)

Dynamic

Damping = the absorption of the energy of oscillations

ADVANTAGES OF USING MAP

 least dependent on measurement site or technique (whether invasive or not)

 MAP is relatively independent of distal waveform amplification
 least altered by dynamic calibration issues (resonance & damping)
 determines tissue blood flow via autoregulation which is proportional to MAP
PRESSURE

P = Force/Area

- Any gas/liquid exerts pressure in all directions

- Eg a syringe with air can be pressurized by applying force to the plunger
- Amount of pressure generated depends on the cross sectional area of the barrel since this is
where the force acts
- So pressure generated in a syringe small bore is greater than that in a large bore syringe, if
the same pressure is applied
- SI unit = Pascal
- Pascal is the pressure = 1 newton/1m2
-