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BP & CVP
J Kayle Lee MD
11.19.2009
Objectives
arterial pressure monitoring
noninvasive methods
invasive arterial monitoring
arterial waveform interpretation
pressure transducer
zeroed at level of aortic root
continuous infusion of saline +/- heparin
Sites
[9]* 80 1 9 0 0 - - -
[9]* 34 1 10 0 2 - - -
[10] 100 0 35 - - - - -
[11] 148 0 27 - - - - -
[12] 29 0 5 - - - - -
[13] 62 0 16 0 0 - - -
[14] 333 0 100 0 16 - 29 -
[15] 40 0 2 - - - - -
[16] 100 2 14 0 1 - 31 -
[17] 197 0 3 3 4 2 - 1
[18] 178 0 7 1 3 - - 1
[5] 1699 0 360 0 1 - 206 -
[19] 26 0 6 0 1 1 1 -
[20] 100 0 14 - - - - -
[21] 100 0 33 0 1 - 13 -
[22] 118 0 18 0 0 - 21 -
[23] 200 0 15 - - - 61 -
[24] 25 0 3 0 0 - - -
[25] 200 0 60 0 0 - 32 -
[26] 193 0 50 0 4 - - -
[27] 88 0 15 - - - - -
[28] 2900 - - 4 12 5 - -
[29] 38 0 3 - - - 5 -
[30]* 45 0 4 - - - 10 -
[30]* 44 0 11 - - - 9 -
[31] 12,500 - - - - 6 - -
[32] 40 0 11 - - - - -
Mean incidence (%) 0.09 (4/4217) 19.7 (831/4217) 0.13 (8/6245) 0.72 (45/6245) 0.09 (14/15,623) 14.40 (418/2903) 0.53 (2/375)
Femoral Site Complications
Permanent
Temporary Pseudoaneurysm
Reference Cases ischaemic damage Sepsis (n) Local infection (n) Haematoma (n) Bleeding (n)
occlusion (n) (n)
(n)
[49] 46 - - 0 - - - -
[50] 50 0 1 0 - - 5 -
[51] 85 0 0 0 - - 10 -
[17] 113 0 0 0 0 - - 4
[52] 89 - - 0 0 - - 1
[53] 2100 - - 6 - 6 - -
[18] 114 0 4 2 0 - - 0
[54] 42 0 1 0 1 - 3 -
[55] 220 0 1 4 4 - 8 -
[19] 64 0 3 1 0 - 2 -
[56] 976 3 - - - - - -
Mean incidence (%) 0.18 (3/1664) 1.45 (10/688) 0.44 (13/2923) 0.78 (5/642) 0.3 (6/2100) 6.1 (28/461)
1.58 (5/316)
Arterial Waveform Analysis
a systolic upstroke
contractility
b area under the curve
stroke volume
c systole
myocardial O2 consumption
c/d jn dicrotic notch
closure of AV
d diastole
myocardial O2 supply
Peripheral Artery Waveform
dicrotic notch is less pronounced peripherally
radial SBP is ~20mmHG higher than aorta
MAP is nearly equal
catheter whip
esp w femoral artery
MAP should be reliable
Central Venous Pressure
estimate with JVP
5 + ht above angle of Louis
measure with CVC, PICC, or PAC
tubing, manometer, or digital transducer
phlebostatic axis
MAL & ICS 4