Hemodynamic Monitoring Review Cram Katie Wheeler, RN, BSN,CCRN Nurse Clinician, Cardiac Surgery Wellstar Kennestone Hospital

Katie.wheeler@wellstar.org I. Non-Invasive Monitoring info about cardiac output a. Pulse Assessment presence, quality b. Neuro mentation?, LOC, GCS c. BP cuff BP has limitations d. UOP adequate? e. Skin Color/temp i. i.e. pale, cool, clammy, cyanosis? Invasive Monitoring a. Types: i. Arterial Pressure ii. CVP iii. PA iv. PAOP Terms a. Preload b. Afterload c. Contractility Indications for Invasive Monitoring: a. Shock States i. Hypovolemic ii. Cardiogenic iii. Septic iv. Distributive** Technical Considerations: a. Transducer Setup i. No air bubbles ii. Phlebostatic axis iii. Considerations for transport iv. Square wave test Arterial Lines

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a. Insertion Sites b. Indications c. Complications d. Waveforms e. Troubleshooting and considerations for air transport CVP/Central lines a. Insertion Sites b. Indications c. Complications d. Waveforms e. Troubleshooting and considerations for air transport PA Catheters a. Insertion Sites b. Indications c. Complications d. Waveforms i. RAP/CVP ii. RV iii. PA iv. PAOP e. Troubleshooting and considerations for air transport Other data provided from the PA catheter: a. Cardiac Output/Cardiac Index b. SVR/SVRI c. PVR/PVRI d. SV/SVI Pharmacology Use Hemodynamic Values to guide treatment a. Fluids first!!! i. Examples 1. NS 2. LR 3. albumin 4. blood ii. Indications iii. titration b. Vasopressors

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i. Examples epi, norepi, dopamine, neo ii. Indications iii. titration c. Vasodilators i. Examples NTG, Nipride, Cardene ii. Indications iii. Titration

IABP: I. II. III. IV. V. Indications What it is What it does Setup Monitoring a. Triggers b. IABP console only! c. Monitored values i. Unassisted sys & dias. ii. Assisted sys & dias. iii. Mean iv. Augment

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Considerations for Transport Complications a. Rupture b. IABP failure c. Bleeding d. Arrest situations e. Clotted line Waveforms a. Normal b. Timing errors i. Early inflation* ii. Late inflation iii. Early deflation iv. Late deflation*