hemo_mont.

qxd
(sec) Hemodynamic Monitoring Determining the Accuracy of Hemodynamic Values
0.1 0.3 0.5 0.7 0.9 1.1 1.3

0.2 0.4 0.6 0.8 1.0 1.2 1.4 Parameter Normal Importance Steps Technique How often should it
Value be done?
REF

PR, QRS, and QT interval

SvO2 60-70% The SvO2 helps identify which Level the trans- Place any stopcock at the phle- Only if the patient has
Indicates adequacy of blood pressue and cardiac ducer to the phle- bostatic axis. Patient should moved from the origi-
tissue oxygenation, the output are acceptable for bostatic axis be supine. Elevation can be nal position. Relevel if

11/1/00
primary reason many each patient. from flat to 45 degrees reading has unexplain-
30

ably changed.

MM
patients receive hemo-
dynamic monitoring
Zero the With the stopcock off to the Must zero on initial
Stroke Index (SI) 25-45 Used in conjunction with cardiac Transducer/amplifier patient and open to air, cap setup. Rezero if read-

1
How much blood is ml/m2 pressures to diagnose and removed and leveled at the phle- ings have unexplain-
Heart rate at 25 mm/sec (Measure two cardiac cycles from the reference arrow)

pumped with each beat evaluate treatment. bostatic axis, activate the moni- ably changed.
35

8:03 AM
referenced against body tor’s zero function. Close trans-
Hemodynamic size. ducer to air and open to patient

2
and then recap stopcock.
Cardiac Index 2.5-4.0 Not as early an indicator of a

Monitoring How much blood is L/m/m2 hemodynamic problem as stroke Perform a square Activate the fast flush device Prior to obtaining
40

pumped during one index due to the compensating wave test. The and release. Interpret the readings
3 minute reference role of heart rate when stroke square wave test response.

Page 1
against body size. It is index is low. checks the accura- See illustration below It is better way of
45

a product of stroke cy of the tubing/ verifying the arterial

index and heart rate catheter system. line accuracy than
4

the blood pressure

50

Pulmonary artery About Useful in assessing response to cuff comparison.

pressure (PAP) 25/10 therapies for pulmonary
55

mmHg hypertension. Normally not a

Performing Square Wave Test
5

primary parameter in assessing

60

hemodynamics. Characteristics Illustration How to correct? Clinical Result

Pulmonary artery About When the stroke index is low,
Waveforms are
70

occlusive pressure 8-12 the PAOP helps differentiate left Optimal Dampening No necessary
6

(PAOP or wedge) mmHg ventricular dysfunction 1) Should have a small correction accurately
overshoot, followed by reproduced
100 90 80

(PAOP>12mmHg) and
hypovolemia (PAOP< 8mmHg). a small overshoot
(about 1/3 the distance
7

Central venous pressure About When stroke index is low, the of the undershoot)
(CVP) 2-6 mmHg CVP helps differentiate right ven- 2) Should have 1-2 blocks
Right atrial pressure. A tricular dysfunction (CVP> 6 between oscillations
reflection of right ven- mmHg) and hypovolemia (CVP is
Under Dampening 1) Remove
8
200 150

tricular end diastolic normal or < 2 mmHg.

pressure. The CVP is an 1) Either extra oscillations excess tubing.
estimation of preload. are present or 2) Insert
2) Prolonged distance dampening
Blood Pressure Varies with A common less invasive form of (more than 2 blocks device
9
400 300

Reflects pressure in sys- site, size, estimating blood flow. With between bounces.
temic arterial system. age and hemodynamic monitoring
sex. available (SvO2, SI, CI), blood Over Dampening Find source of Systole is artifi-
cially depressed,
10

pressure is less useful. 1) Obstruction in line problem.

REF prevents oscillation 1) Air in line diastole may be
A supplement to CRITICAL CARE NURSE® Systemic Vascular 900-1300 Often used to assess the 2) Note slurring on 2) Blood in line higher than
Resistance (SVR) dynes/sec/ response of arterial dilators. downstroke. 3) Kink in tub- actual.
cm5 ing/catheter Use mean
values if unable
to correct.
5968-6249E Printed in the USA, July 1999
 hemo_mont.qxd
How to read a CVP waveform How to read a Right Ventricular & PA waveform Avoiding Respiratory Artifact
Method Technique Indications Waveform Characteristics Example Types of How to Read Example
Artifact
Pre C wave Find the c Theoretically the Right Ventricular 1) Rapid upstroke to
wave on the most sound waveform systole. Systole found Patient initiated - 1) Locate where the
downstroke of method. Use this after the QRS but before includes baseline drops
the a wave method if possible the T-wave. spontaneous 2) Read the last

11/1/00
(usually near 2) Terminal diastolic breathing and clear wave before
the end of the rise-diastole found near patient initiated the drop occurs
QRS complex) the end of the QRS ventilator breaths
complex

Pulmonary 1) Rapid upstroke to

Artery waveform systole. Systole found

8:03 AM
after the QRS but before
the T-wave.
2) Progressive diastolic
runoff-diastole found Mechanical 1) Locate where the
Average of the Find the a Often the easiest near the end of the Ventilation baseline moved
a-c waves wave in the to use since the c QRS complex. upward

Page 2
PR interval. waves are not 3) A dicrotic notch (closure 2) Read the last
Locate top always visible. Use of the pulmonic valve) is clear wave before
and bottom this method if c sometimes visible during the baseline
of a-c wave. wave is not the progressive diastolic elevates.
Average the present. runoff.
two values.

How to read a PAOP waveform

Avoiding Abnormal Waveforms
Method Technique Indications
Clinical How to Read Example
Average of the Find the a wave Often the easiest Situation
a-c waves after the QRS to use since the c
complex. Locate waves are not Large V wave Locate the pre c point
top and bottom always visible. Common with or the mean of the a-c
Z point Draw a line Use this method CHF wave before the large V
down from when no clear a of a-c wave. Use this method
Average the if c wave is not wave.
the end of or c wave present.
the QRS (e.g. atrial two values. present
complex. fibrillation and
Where the paced rhythms)
line hits the
baseline, is
the CVP
reading. Large or absent a Use the Z point method.
Z point Draw a line down Use this method
from about .08 to when no clear a wave
.12 seconds after or c wave present
the QRS complex. (e.g. atrial fibrilla-
Where the line hits tion and paced
the baseline, is the rhythms)
PAOP reading.