1. Understanding Adult Hemodynamics Theory, Monitoring, Waveforms and Medications Vicki Clavir RN

3. Objectives Understands basic cardiac anatomy Verbalizes determinates of Cardiac Output and their relationships to each other List indications for hemodynamic monitoring Demonstrates monitor system and set up Describe pharmacologic strategies that manipulate the determinates of cardiac output

6. Coronary Arteries RCA- RA, RV&LV Inf, Inf Septum SA node 65% AV node 80% PDA 80-90% CX- LA,LV ( side/back) SA node 40% AV node 20% LAD – LV (front/bottom) Septum Bundle branches Left Main

8. Cardiac Cycle Diastole Phase SA node contracts. Atria contract. Ventricles fill with more blood. Contraction reaches AV node . Late Diastole Atria and Ventricles are relaxed. Semilunar valves are closed. Atrioventricular valves are open. Ventricles continue to fill with blood. Mid Diastole Ventricles relax. Semilunar valves close. Atrioventricular valves open. Ventricles fill with blood. Early Diastole Cardiac Cycle Systole Phase Contraction passes from AV node to Purkinje fibers and ventricular cells. Ventricles contract. Atrioventricular valves close. Semilunar valves open. Blood is pumped from the ventricles to the arteries. Systole

9. Cardiac Cycle

12. The Cardiac Cycle

14. The Cardiac Cycle

15. The Cardiac Cycle

16. Normal CO 4-8 liters Normal Cardiac Index is 2.5 to 4.5 liters

24. Increased Preload

25. Decreased preload

26. Normal Value - 2-8 mm Hg

27. Or LVEDP PAOP = 8-12 mm Hg PAD = 10-15 mm Hg

34. X Y

37. Normal PVR is 120 to 200 dynes

38. Normal SVR - 800-1200 dynes

44. EKG

55. O2 O2 O2 O2 O2 O2 O2 To BODY From Body

56. O2 O2 O2

62. PA Catheter KEEP COVERED KEEP LOCKED YELLOW Clear BLUE RED Markings on catheter. 1. Each thin line= 10 cm. 2. Each thick line= 50 cm.

63. Description of PA Catheter Ports/lumens. CVP Proximal (pressure line - injectate port for CO)- BLUE PA Distal (Pressure line hook up)- Yellow Extra port - usually- Clear Thermistor – Red Cap

64. Continuous Cardiac Output and SVO 2 monitoring

66. PRESSURE TRANSDUCER SYSTEMS SET UP

68. 500 ml Premixed Heparinized bag of NS

70. PHLEBOSTATIC REFERENCE POINT

71. ♥ Re-level the transducer with any change in the patient’s position ♥ Referencing the system 1 cm above the left atrium decreases  the pressure by 0.73 mm Hg ♥ Referencing the system 1 cm below the left atrium increases  the pressure by 0.73 mm Hg Angles 45° 30° 0 °

73. Remove cap and keep sterile Turn stopcock towards pressure bag Zero monitor Replace cap

78. ARTERIAL WAVEFORM

79. RN magazine April, 2003 - PA catheter refresher course.

81. ALL PA measurements are calculated at end expiration because the lungs are at their most equal - (negative vs. positive pressures)

83. a, c,& v Waves and their Timing to the ECG tracing

86. RA WAVEFORM

88. RV WAVEFORM 22 4

89. Ventricular

105. PAW WAVEFORM WITH MECHANICAL VENTILATION

111. OVERWEDGE