INVASIVE PRESSURE MONITORING

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

 1. Arterial Blood Pressure Monitoring

2 . Central Venous Pressure Monitoring

3. Pulmonary Artery Pressure Monitoring 4. Intra Cranial PressureMonitoring 5. Intra Abdominal Pressure Monitoring

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

Pressure transducer
Air mineture rugged and disposable device

These device can convert the movement of the sensing diaphargm into an electrical signal

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

DISPLAY
Pressure waveforms are visualised on a calibrated oscilloscope

Digital displays provide a simple method for presenting quantitative data from the pressure waveform

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

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

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

CENTRAL VENOUS PRESSURE

 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

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

PULMONARY ARTERY PRESSURE

 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)

 HAEMODYNAMIC MEASUREMENTS 1.CARDIAC OUTPUT a.injectate 10ml 5% dextrose @ room temp b.inject througout the resp cycle c.>3 measurements and ignore values>10% from average 2.DERIVED VARIABLE a.CO/CI and SVR b.PVR(I), SV(I),LVSWI,RVSWI