Hemodynamics and Flight :Hemodynamics and Flight Hoops Day Education


Slide 3:Invasive Line Transports


Important to Know? :Important to Know? Basic principles of hemodynamics Monitoring procedures Wave form recognition Appropriate interventions Trouble shooting ideas Appropriate documentation Flight physiology


Principles of Hemodynamics :Principles of Hemodynamics Relationship between pressure, flow and the resistance in the circulatory system It is important to focus on how these relationships interact with each other Cardiac output Systemic vascular resistance Blood pressure Life is a Pressure Gradient


Determinants of Cardiac Output :Determinants of Cardiac Output Heart rate Preload Afterload Contractility Stroke Volume


Stroke Volume :Stroke Volume Definition Quantity of blood pumped by the heart per cardiac cycle and it is expressed as ml/beat Normal Values 50 to 100 cc per beat Overall evaluation of pump function


Slide 8:Here is your patient Are you prepared?


Slide 9:Balloon inflation port Thermistor Connector RV Distal Port RA Proximal Port Proximal infusion Proximal injectate RV Infusion Balloon Thermistor Distal infusion


Preparation for Transport!! :Preparation for Transport!! Hit It !!


Slide 12:We're Here !!


Ready to Roll…. :Ready to Roll…. Receive report Note previous readings Prime tubing Level system Zero system Begin Monitoring


System Leveling :System Leveling Phleboststic Axis 3rd-4th intercostal space mid-axillary line


Leveling :Leveling Level to the stop cock: air fluid interchange


Zero Referencing :Zero Referencing Purpose eliminates the pressure influences Procedure stopcock off to the patient press the zero function key on the monitor


Transducer Calibration :Transducer Calibration Optimally dampened Over dampened Under dampened Dynamic Response


Slide 18:Waveforms


Central Venous Pressure :Central Venous Pressure Normal Values 2-6 mm/Hg


Actual Patient :Actual Patient Central Venous Waveform


Ventricular Waveform :Ventricular Waveform Normal Values 20-30 Systolic 2-6 Diastolic


Actual Patient :Actual Patient Right Ventricular Waveform


Waveforms :Waveforms Dicrotic Notch Closing of the pulmonic valve Normal Values 20-30 10-20


Wedge Pressure Waveform :Wedge Pressure Waveform Normal Values 4-12


Proper Wedge Technique :Proper Wedge Technique Balloon Inflated Appropriate waveform Occludes artery


Actual Patient :Actual Patient Balloon inflated Pulmonary Artery Wedge Pressure Waveform


Improper Wedging :Improper Wedging Balloon Inflated Over wedged waveform


Over Wedged Example :Over Wedged Example Balloon inflated Over wedged


Slide 29:Be Aware Of Ventilation


Slide 30:Non Ventilated PAW Tracing inspiration End expiration


Effects of Positive Pressure Ventilation :Effects of Positive Pressure Ventilation inspiration End expiration


Paw and the Vent actual :Paw and the Vent actual


Actual Patient Waveforms during Insertion :Actual Patient Waveforms during Insertion RA to RV


Ventricular Waveform :Ventricular Waveform RA to RV


Ventricular to Pulmonary Artery :Ventricular to Pulmonary Artery RV to PA


PA Wedge to Pulmonary Artery :PA Wedge to Pulmonary Artery PAW to PA


Slide 37:Lets Have Some Fun


Artline Pressure VS Cuff Pressure :Artline Pressure VS Cuff Pressure Gold standard Care provider preference


Arterial Waveform :Arterial Waveform Systolic Peak Diacrotic Notch End Diastolic Pressure


Arterial Line and V-Tach :Arterial Line and V-Tach


Arterial Line and 3rd º AVB :Arterial Line and 3rd º AVB


Complications :Complications Ischemia Necrosis Embolism Hemorrhage Infection Hematomas Thrombocytopenia


Complications :Complications Infection Balloon Rupture don’t continue to attempt to inflate Embolus balloon rupture removal Thrombocytopenia Displacement Arrhythmia's Damage to the pulmonic valve Kniked and/or Knotted Catheter Pulmonary Infraction/Rupture Spontaneous wedging


Slide 44:Monitoring Problems No Waveform check stopcocks check scale monitor/ transducer not functioning clotted or kinked catheter asystole Dampened Waveform air/blood in line clot on the cath tip disconnected or loose tubing underinflated pressure bag cath tip against wall compliant tubing


Slide 45:Monitoring Problems Continued Underdampened wave form too many stop cocks/ tubing tiny air bubbles defective transducer


Trouble Shooting :Trouble Shooting Numbers that just don’t fit….


Slide 47:Assessment Review the pre-change over readings and waveform assessment Review post change readings and waveform assessment Are they the same ?? Air in the line kinks is the scale appropriate ?


Slide 48:Assessment Be aware of the ventilatory status this can and will change things Depth of insertion Condition of the insertion site Review the CXR Confirming placement R/O Pneumothorax Confirm all connections are tight


Slide 49:Documentation Assessment of the site Depth of insertion Waveform placed on the chart Condition of the site if abnormal CXR


Review :Review Name some complications associated with pulmonary artery monitoring….. If you suspect the catheter is clotted off, what is the most appropriate intervention? If the balloon is ruptured, how will you know? What should you do? How do you intervene with a catheter that is spontaneously wedging?