HEMODYNAMIC MONITORING

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 OBJECTIVE
1. Describe the three attributes of circulating blood and their relationships.

2. Identify types of clients in which hemodynamic monitoring would be

indicated.

3. Describe the types of catheters used for hemodynamic monitoring.

4. Discuss the normal and abnormal values obtained through

hemodynamic monitoring as they relate to specific client situations.

5. List the potential complications in use of hemodynamic monitoring

devices.

6. Explain nursing responsibilities when caring for patient on

hemodynamic monitoring.

7. Describe the procedure for setting up a hemodynamic circuit.

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 HEMODYNAMIC
MONITORING
• DEFINITION:
Using invasive technology to provide
quantitative information about vascular
capacity, blood volume; pump
effectiveness, and tissue perfusion

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 HEMODYNAMIC
MONITORING
• ATTRIBUTES OF CIRCULATING
BLOOD: 
1. PRESSURE

2. RESISTANCE

3. Flow

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 HEMODYNAMIC
MONITORING
• TYPES OF CATHETERS USED FOR
HEMODYNAMIC MONITORING:
1. Pulmonary Artery Catheter (swan
ganz)

2. Arterial Pressure Catheters

 
3. Central Venous Pressure or CVP
monitoring
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 HEMODYNAMIC MONITORING
• INDICATIONS FOR HEMODYNAMIC
MONITORING:

1. Potential or actual alteration in CO

2. Potential or actual alteration in fluid

volume 

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 HEMODYNAMIC MONITORING
• PULMONARY ARTERY MONITORING
EQUIPMENT

1. Invasive catheter (swan ganz)

2. Transducer

3. Amplifier/recorder

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 HEMODYNAMIC MONITORING
• SWAN GANZ CATHETER

a. Distal Lumen: the PA (pulmonary artery)

b. Proximal Lumen: (CVP port)
c. Inflation Balloon 
D. Thermostat Lumen
e. Additional Lumens
* VIP - venous infusion port
* Pacing Port-
 

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 HEMODYNAMIC MONITORING
• Assessment Data, Pressures, Waveforms of
the swan ganz catheter 
a. RAP or CVP  
b. PAP -
c. PCWP (PAWP)  
d. Waveforms: RAP, RVP, PAP, PCWP 
e. Using Pressures to Calculate Other
Hemodynamic Variables 
* CO, CI, MAP, SVR, PVR 

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 HEMODYNAMIC MONITORING
• NURSING RESPONSIBILITIES
1. Pre-Insertion: 
a. Patient & significant others
teaching.
b. Thorough baseline assessment
c. Equipment set-up
d. Positioning of the client
e. Equipment check (calibration, zero
etc.) 
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 HEMODYNAMIC MONITORING
NURSING RESPONSIBILITIES
2. Insertion,
(patient is often awake for the
procedure)
a. Collaboration
b. Assist with equipment preparation
c. Monitor patients response to
treatment
e. Recording 
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 HEMODYNAMIC MONITORING
NURSING RESPONSIBILITIES
3. Post-Insertion 
a. Chest X-ray for placemen
b. Sterile OCCLUSIVE dressing, stabilization
of the catheter
c. Patient comfort
d. Assess and document pressures/data
e. Catheter maintenance
f. Monitor patients response

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 HEMODYNAMIC MONITORING
NURSING RESPONSIBILITIES
• Maintenance of the System:
a. Label and date lines, change tubing as per
unit policy
b. Maintain & change dressing
c. Alert for waveform and pressure changes
d. Maintain pressure/pressure bag
e. Keep balloon deflated between PCWP
readings
f. Collaboration and communication with
physician
g. Remember to care for the patient as well as
your equipment

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 Zeroing
• hydrostatic pressuremeasurements
• CVP of 10 mmHg at an atmospheric pressure
of 760 mmHg is actually 770 mmHg.
 Phlebostatic Axis

• 4th intercostal space, mid-axillary line

• Level of the atria

(Edwards Lifesciences, n.d.)

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Dynamic Flush

Dynamic flush ensures the integrity

of the pressure tubing system.
Notice how it ascends - forms a
square pattern - and bounces below
the baseline before returning to
the original waveform.
•Check dynamic flush after zeroing
any pressure tubing system

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 HEMODYNAMIC MONITORING
• POTENTIAL COMPLICATIONS 
1. Dysrhythmias
2. Infection
3. Pneumothorax
4. Pulmonary infarction
5. Balloon rupture and air embolism
6. Pulmonary artery rupture
7. Endocarditis  

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 HEMODYNAMIC MONITORING
• ARTERIAL PRESSURE MONITORING:
1. Indications
2. Assessment data:  
* MAP = (diastolic x 2)+(systolic)
3
* MAP - ICP = CPP 

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 HEMODYNAMIC MONITORING
• ARTERIAL PRESSURE MONITORING:
3. Arterial Waveform 
a. Aortic valve opens and blood is ejected from
LV and is recorded as an increase in pressure

b. Highest point represents systole

c. Lowest point is diastolic pressure 

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 HEMODYNAMIC MONITORING
• ARTERIAL PRESSURE MONITORING:
• 4. Nursing Responsibilities
• 5. Potential Complications:
a. Thrombosis at catheter tip
b. Infection
c. Bleeding
d. Loss of flow distal to extremity
 

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 Nursing Responsibilities
• Prepare the setup and the circuits
• Assist in the procedure
• Caring for equipments as well as for the
patient.
• Calibration
• Obtaining the readings
• Interpreting the results and informing the
physician
• Providing the suitable management
• Documenting
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 Swan Ganz Cathetarization

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 PROCEDURE FOR SETTING UP A
HOMODYNAMIC CIRCUIT
• Equipment Required:
1.  2 single transducer kit
2.  2 Pressure bags
3.  2 500 mL bag of .9 NaCl with1,000 units of
heparin
4.  2 transducer clamp
5.  2 pressure cable connected to Protocol
monitor

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