HEMODYNAMIC

MONITORING
 Hemo
Dynamics
Hemo + Dynamics = Movement
Blood Movement of blood
flow
 DEFINITION
It is the use of invasive and non-invasive
technology to provide quantitative information
about vascular capacity, blood volume, pump
effectiveness and tissue perfusion.
 PURPOSES
• Early detection, identification and
treatment of life threatening
conditions.
• Evaluate patient’s immediate response
to treatment.
• Evaluate the cardiovascular functions.
 INDICATIONS
 Any deficit or loss of cardiac function

 Shock

 Monitor and manage unstable patients

 Assess hemodynamic response to therapies

 Suspected anatomical lesions

 HEMODYNAMIC
TERMINOLOGIES
o Cardiac output & Cardiac index

o Stroke volume & Stroke volume index

o Vascular resistance

o Preload & Afterload

 METHODS OF HAEMODYNAMIC
MONITORING

• Non invasive hemodynamic assessment

• Arterial Blood Pressure
 Non-invasive
 Direct arterial pressure measurement
• Central Venous Pressure
• The Pulmonary Artery Catheter
• Cardiac Output Measurement
 ARTERIAL BP MONITORING

 Indirect methods

• Traditional method of cuff and mercury manometer

• NIBP machine or oscillometry

 Direct methods
• Intra-arterial catheter / transducer system
 TYPES

1. Invasive pressure monitoring

2. Non-Invasive pressure monitoring

Traditional method of cuff and
mercury manometer
 OSCILLOMETRIC METHODS

•With an electronic pressure

sensor (transducer) fitted in
to detect blood flow,
• The pressure sensor is a calibrated
electronic device with a numerical readout
of blood pressure.
 Advantages of non invasive BP
monitoring
• Simpler and quicker than invasive
measurements
• Require less expertise in fitting
• Have virtually no complications
Limitations of Non-invasive Blood
Pressure Monitoring

• Cuff must be placed correctly and must be

appropriately sized
— Auscultatory method is very inaccurate
— Korotkoff sounds difficult to hear
— Significant underestimation in low-flow (i.e. shock)
states
• Oscillometric measurements also commonly
inaccurate (> 5
mm Hg off directly recorded pressures)
INVASIVE PRESSURE
MONITORING
DIRECT INTRA
ARTERIAL BP
MONITORING
ARTERIAL LINE
Arterial line

Uses

• Record blood pressure

(systolic, diastolic, mean and
pulse pressure)
• Arterial blood sampling
 INDICATIONS
• Acute hypertension or hypotension
• Respiratory failure
• Shock
• Neurologic injury
• Coronary interventional procedures
• Vasoactive drug infusion
• Frequent ABG sampling
Arterial line BP monitoring
Specific indications
• Labile blood pressure

• Anticipation of haemodynamic

instability
• Titration of vasoactive drugs
• Frequent blood sampling
• Morbid obesity (unable to fit an
appropriately sized NIBP cuff)
CONTRAINDICATIONS

Absolute contraindications

• Absent pulse

• Thromboangiitis obliterans (Buerger

disease)
• Full-thickness burns over the
cannulation site
• Inadequate circulation to the extremity

• Raynaud syndrome
CONTRAINDICATIONS
Relative contraindications
• Anticoagulation
• Atherosclerosis
• Coagulopathy
• Inadequate collateral flow
• Infection at the cannulation site
• Partial-thickness burn at the cannulation
site
• Previous surgery in the area
• Synthetic vascular graft
 CONTRAINDICATIONS
 Absent collateral circulation
Local infection
 Vascular insufficiency
 Raynaud’s phenomenon
 COMPLICATIONS
• Ischemia
• Haemorrhage
• Ecchymosis
• Air embolism
• Thrombus formation
• Pain
• Ateriospasm
-Site selection
• Radial artery

• Brachial artery.

• Dorsalis pedis artery.

• Femoral artery
 Arterial BP monitoring system
• An intravascular catheter.
• A fluid-filled electro-mechanic monitoring system
containing tubing, pressure transducer, and flush
system.
• A monitor containing an amplifier to convert the small
electronic signal generated by the transducer to a
waveform that is displayed on a screen
 COMPONENTS
1. Arterial catheter
2. Pressure tubing
3. Pressure cable
4. Transducer
5. Pressure bag
6. Pressure gauge
7. Flush system
8. Electronic monitoring system
Arterial BP monitoring system
 PROCEDURE

 AllEN’S TEST
Arterial cannula

A short, narrow, parallel

sided cannula made of
polyurethane or Teflon™

Larger gauge cannula

increase the risk of
thrombosis, smaller
cannula cause damping
of the signal.
Fluid filled tubing

• This is attached to the arterial cannula, and provides a

column of non compressible, bubble free fluid between
the arterial blood and the pressure transducer for
hydraulic coupling
• This tubing should be colour coded with red or clearly
labelled.
• A 3way tap is incorporated to allow the system to be
zeroed and blood samples to be take
Transducer

Converting the
pressure
waveform into
an electrical
signal
Infusion/flushing system
• A bag of either plain 0.9% saline
or heparinised 0.9% saline is
pressurized to 300mmHg
• This allows a slow infusion of
fluid at a rate of about 2-4ml/hour
to maintain the patency of the
cannula.
• Signal processor, amplifier and display

Arterialine monitoring system

NORMAL WAVE-FORM
 Articles
• Tape
• An arm board or towel roll
• Opsite or Tegaderm cover dressing
• Local anesthetic (1% or 2% lidocaine ,lidocaine cream)
• Suture material for femoral arterial line placement (2.0 silk)
• Scissors
• Monitor cable for transducing arterial waveform.
• Antiseptic solution