Hemodynamic Monitoring in addition to Transthoracic Lines Deb Updegraff RN, CNS Lucille Pac

Hemodynamic Monitoring in addition to Transthoracic Lines Deb Updegraff RN, CNS Lucille Pac www.phwiki.com

Hemodynamic Monitoring in addition to Transthoracic Lines Deb Updegraff RN, CNS Lucille Pac

Lekas, Bill, Host has reference to this Academic Journal, PHwiki organized this Journal Hemodynamic Monitoring in addition to Transthoracic Lines Deb Updegraff RN, CNS Lucille Packard Children’s Hospital Pat Hock RN, Nurse Educator Winnie Yung , CNS Infants in addition to children undergoing open heart surgery may require intracardiac monitoring. The hemodynamic data can assist in the assessment of contractility, preload in addition to afterload. As the patient stabilizes post cardiac by-pass, intracardiac catheters (RA) may be left in place as long as vascular access reasons. What’s the difference “Percutaneous” vs “Transthoracic” Percutaneous – Insertion site is through the skin. Transthoracic- Insertion is done while the chest is open in addition to directly through the myocardium.

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Examples of Percutaneous lines: PICCs Tunneled lines Non-tunneled lines Swan-Ganz thermodilutional catheters Dialysis/CRRT catheters Examples of Transthoracic Lines Roth, S. 1998 Percutaneous Central Venous Catheter Left Atrial Transthoracic Catheter Right Atrial Transthoracic Catheter LA RA PA Pulmonary Artery Catheter

Hemodynamic Wave as long as ms- Normal Heart (CVP) Right Atrial Pressure Monitoring Indications Measure right atrial pressure (RAP) Same as Central Venous Pressure (CVP) Assess blood volume; reflects preload to the right side of the heart Assess right ventricular function Infusion site as long as large fluid volume Infusion site as long as hypertonic solutions Reasons as long as elevated RA pressure: decreased right (or single) ventricle compliance tricuspid valve disease Intravascular volume overload cardiac tamponade tachyarrhythmia Right Atrial Pressure Mean: 1 to 7 mm Hg

Reasons as long as reduced RA pressure: low intravascular volume status inadequate preload Right Atrial Pressure Mean: 1 to 7 mm Hg Right Atrial Pressure Monitoring Complications Pneumothorax Hemothorax Hemorrhage Cardiac tamponade Vessel, RA, or RV per as long as ation Arrhythmias Air embolism Pulmonary embolism Thromboembolism Infection Right Atrial Pressure Monitoring Wave as long as m Analysis a wave: rise in pressure due to atrial contraction x decent: fall in pressure due to atrial relaxation c wave: rise in pressure due to ventricular contraction in addition to closure of the tricuspid valve v wave: rise in pressure during atrial filling y decent: fall in pressure due to opening of the tricuspid valve in addition to onset of ventricular filling

Right Atrial Pressure Monitoring Wave as long as m Analysis Elevated RAP RV failure Tricuspid regurgitation Tricuspid stenosis Pulmonary hypertension Hypervolemia Cardiac tamponade Chronic LV failure Ventricular Septal Defect Constrictive pericarditis Decreased RAP Hypovolemia Increased contractility Elevated systemic ventricular end diastolic pressure mitral valve disease Large left-to-right shunt intravascular volume overload cardiac tamponade tachyarrhythmia Artifactual Reasons as long as elevated LA pressure: low intravascular fluid status Inadequate preload Artifactual Reasons as long as reduced LA pressure:

Reasons as long as elevated PA pressure: mechanical obstruction of pul. circulation pul. arteriolar smooth muscle hypertrophy inflammatory response to CPB mechanical obstruction of the airways ( as long as examples ) acidosis in addition to hypoxia elevated LA pressure unrestrictive VSD or large PDA pul. hypertension Nursing HOURLY assessment: Air in line or stopcocks Precipitates Leaking at site Increasing resistance Condition of entrance sites Check coagulation labs (pt, ptt, INR, platelets) Transfuse if Platelets < than 70 in addition to INR > 1.5 Ensure Packed Red Blood Cells in cooler at bedside (Remember two RN check as long as PRBCs. Instructions as long as blood in cooler, taped to cooler) Ensure good vascular access Ensure chest tube patency Evaluate need as long as sedation. (if too active BP may bleeding) BEFORE REMOVAL Transthoracic Line

After Removal of Transthoracic Line Keep PRBCs as long as a minimum of 1 hour Continuous hemodynamic monitoring as long as a minimum of 1 hour (assess as long as signs of tamponade-dampening arterial wave as long as m narrowing pulse pressure in addition to bleeding- blood in chest tubes, decrease blood pressure, pallor altered LOC) Document vitial signs every 15 minutes Check HCT if bleeding suspected Ensure patency of chest tubes Do not transfer patient as long as at least 2 hours Pressure Line Safety What is air vigilance in addition to why is it so important Why is it unsafe to draw back or flush fluid into a line infusing vasoactive medications What precautions should be taken when discontinuing any pressure line Is it safe to get a patient out of bed to be held or to sit in a chair if they have a transthoracic pressure line What additional safety measures should be followed as long as transthoracic pressure lines References Alspach. AACN’s Core Curriculum as long as Critical Care Nursing. Saunders. Berne in addition to Levy. Physiology. Mosby. Hazinski. Manual of Pediatric Critical Care. Mosby. Kinney, Packa, in addition to Dunbar. AACN’s Clinical Reference as long as Critical Care Nursing. Saunders. Kumm. Hemodynamic Monitoring. University of Kansas School of Nursing. Kumm. Intra-arterial Pressure Monitoring. University of Kansas School of Nursing. Slota. AACN’s Core Curriculum as long as Pediatric Critical Care Nursing. Saunders. Taleghani, Fred. Invasive lines, hemodynamic monitoring, in addition to wave as long as ms. LPCH, PICU.

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