Hemodynamic Monitoring Clear Sight – Noninvasive Monitoring FloTrac – Minimally Invasive Monitoring Susan Volk, MSN, RN, CCRN, CPAN March 2016

Patient Population ClearSight and/or FloTrac monitoring can be used on any patient population Care pathway patients, recurring ventral hernia patients will be monitored preop in P&H, intraoperatively, postop in PACU and for the first 48 hours in TCU

Hemodynamic Monitoring Allows for the assessment of the heart and lungs ability to carry oxygen to the tissues Goals: To ensure the adequate delivery and perfusion of oxygen to the tissue To assess the effects of therapeutic intervention on the delivery and perfusion of oxygen to the tissues

Cardiac Output CO SV Preload Afterload Contractility HR X

Stroke Volume Stroke Volume The amount of volume ejected from the left ventricle per beat (stroke) Affected by Preload, Afterload, and Contractility SV – 60-100 ml/beat SVI – 35-45

Cardiac Output Cardiac Output The amount of blood that is pumped by the heart per unit time, measured in liters per minute (L/min) CO – 4.0-8.0 L/min Cardiac Index Cardiac output divided by body surface area CI – 2.5-4.0 L/min/m2

ClearSight Finger cuff attaches to monitor Arterial line waveform is obtained from ClearSight (arterial line is not in place) SV, CO, CI, & SVR values obtained

FloTrac FloTrac is a pressure tubing attached to an arterial line and connnected to the Edwards monitor SV, CO, CI, SVR values are obtained FloTrac may be used on high risk patients or those with poor perfusion

Preop Abd Wall Reconstruction Patients Apply ClearSight fingercuff to patient Measure width of patient finger Finger cuffs are good for 72 hours Place a pt label with height & weight on the cord of cuff

Preop Enter patient data FIN, height, weight, gender Click on the Home icon after entering the data

Patient Setup Zero monitor & waveform The zero & waveform screen appears Align the HRS & Fingercuff clip & zero Place the HRS at the phlebostatic axis Attach the clip to the end of the fingercuff Zero patient & monitor, click on 0 Edwards monitor, message will appear to zero Phillips monitor, aftering zeroing, click on waveform

Patient Setup To start monitoring, click on green hand icon, so the green (-) turns red Check the stability indicator at the bottom of the screen It will initially be (o) and will then will turn green when the number reaches 30, the highest the indicator goes is 70

Patient Setup Enter CVP of 7 in order to get SVR Click on Medical Bag icon, then click on enter CVP

Periop Goal Directed Fluid Therapy Measure initial SV & CI once stability indicator reaches 30 P&H will administer 250 ml NSS fluid bolus over 10 min Check SV, if SV increases by 10%, administer another 250 ml NSS over 10 min Check SV, if 10% increase after second bolus, contact anesthesiologist for guidance

Documentation Preop PACU Document the initial Stroke Volume & Cardiac Index in a Progress Note, labeled “Hemodynamic Monitoring” Create an addendum in the progress note to document the SV & CI after the boluses Document SV & CI on Edwards Protocol form (place on chart, not permanent part of record) PACU Document the SV & CI every 20 minutes in Powerchart on the Hemodynamic Monitoring Form

Hemodynamic Monitoring Form Access from AdHoc Charting Assessment folder Display in Vital Signs tab

Saving Patient Data Prior to the pt leaving PACU, click on the purple icon, select Data Download, select interva of 5 min, then Start Download A message will appear that data download is complete, remove USB port and leave in PACU office

Tips for Successful Measurements Keeping the patient’s hand warm will aid in perfusion & a better stability indicator The HRS needs to be at the phlebostatic axis (if it is too low, the BP will appear falsely high) The clip that is attached is the finger cuff needs to stay in place (if it is too low SV will appear falsely low) If the patient is saying the cuff is too tight, click on the green hand icon to turn monitoring off and then release the cuff If cuff is released without turning monitoring off, cuff may inflate and start leaking