INVASIVE PRESSURE MONITORING

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INVASIVE PRESSURE MONITORING

• AIM
• Information concerning cardio
• respiratory performance and the
• effects of therapy in critically ill
• patients

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• 1. Arterial Blood Pressure Monitoring
• 2 . Central Venous Pressure Monitoring
• 3. Pulmonary Artery Pressure Monitoring
• 4. Intra Cranial PressureMonitoring
• 5. Intra Abdominal Pressure Monitoring

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THINGS NEEDED

• 1. PRESSURE TRANSDUCER
• 2. DOME
• 3. PRESSURE TUBINGS(arterial extension, 3 way
  stopcock, syringe)
• 4. DISPLAYING UNIT
• 5. TRANSDUCER STAND
• 6. PRESSURE BAG WITH NORMAL SALINE
• 7. CATHETER SET

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Pressure transducer

• Air mineture rugged and disposable device
• These device can convert the movement of the
  sensing diaphargm into an electrical signal

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Pressure tubings

• The catheter and stopcock are normally attached
  to the flush device and transducer by non elastic
  pressure tubing
• Continous flush device-use to fill pressure
  monitoring system and prevent from clotting into
  the catheter by continously flushing fluid
  through the system at the rate of 1 to 3 ml/hr

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DISPLAY

• Pressure waveforms are visualised on a calibrated
  oscilloscope
• Digital displays provide a simple method for
  presenting quantitative data from the pressure
  waveform

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CALIBRATION

• The accuracy of blood pressure measurement
  requires an accurate reference point that is the
  patient mid axillary line
• Zeroing process is done by closing the patient
  side and opening the other end of the three way
  to the atmosphere
• Now press zero

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ARTERIAL PRESSURE

• INDICATIONS
• Routine measurement of systemic blood pressure in
  icu
• Multiple blood gas analysis
• PREFERABLE SITES
• Radial,femoral,dorsalis pedis
• CANNULATION
• Collateral perfusion can be evaluated by modified
  allens test

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• CANNULE
• 20G INSYTE (radial)
• Single lumen 18G seldinger technique (femoral)
• COMPLICATIONS
• Infection
• Thrombosis
• Digital ischemia
• Vessel damage
• Bleeding, Nechrosis, Haemotoma

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CENTRAL VENOUS PRESSURE
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• Indications
  
  1.fliid administration
  
  2.TPN hypertonic solutions
  3.vasoactive
  infusions
  4.monitoring for right atrial
  pressure(CVP)
• PREPARABLE SITES
  1.Internal jugular
  2.subclavian
  
  3.brachial
  4.femoral

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• COMPLICATIONS
  1.At insertion
  
  arterial
  puncture,pneumothorax,haemothorax
  2.passage of wire/catheter
  arrhythmias,perforat
  ion of SVC,RA
  3.Thrombosis
  4.Catheter
  embolism
  

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PULMONARY ARTERY PRESSURE
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• INDICATION
• Haemodynamic measurement(cardiac output, stroke
  volume, systemic vascular resistance)
• Measurement of right heart pressure(RAP,PAP)
• Acute pulmonary hypertension
• Pulmonary embolism
• Cardiac tamponade
• Estimation or preload/left heart filling(PAOP)
• Derivation of oxygen variables(VO2,DO2)

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• HAEMODYNAMIC MEASUREMENTS
  1.CARDIAC OUTPUT
  a.injectate 10ml 5
  dextrose _at_ room temp
  b.inject througout the resp cycle
  c.gt3
  measurements and ignore valuesgt10 from average
  
  2.DERIVED VARIABLE
  a.CO/CI and SVR
  b.PVR(I),
  SV(I),LVSWI,RVSWI