1. Arterial Blood Pressure(ABP) Arterial Blood Pressure(ABP) Central Venous Pressure(CVP) Central Venous Pressure(CVP) Pulmonary Artery Pressure(PAP) Pulmonary Artery Pressure(PAP) Pulmonary Capillary Wedge Pressure(PCWP,PAWP) Pulmonary Capillary Wedge Pressure(PCWP,PAWP) Cardiac Output(CO) Cardiac Output(CO) INVASIVE HEMODYNAMIC MONITORING

2. PULMONARY ARTERY PRESSURE

4. 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)

5. برای ارزیابی از سوند مخصوصی به نام کاتتر سوان گنز که دارای چهار مجرا است استفاده می شود

6. Components of Swan-Ganz [con’t] Normally has four[4] ports – Proximal port – [Blue] used to measure central venous pressure/RAP and injectate port for measurement of cardiac output – Distal port – [Yellow] used to measure pulmonary artery pressure – Balloon port – [Red] used to determine pulmonary wedge pressure;1.5 special syringe is connected – Infusion port – [White] used for fluid infusion

9. 1. وضعیت قرار گیری بیمار 2. تنفس ارادی 3. تهویه مکانیکی

11. Nursing considration Asist with insertion and removal of invasive hemodynamic lines. Asist with Allen test before canulation. CXR after insertion of pulmonary catheter Zero and calibrate equipments each 4-12 hour Monitor hemodynamic parameters and waveforms Compare hemodynamic parameters with clinical conditions Complications of catheters instruct patient and family on theraputic use of hemodynamic catheters

12. Pulmonary artery pressure: – measured by indweling catheters (PAOP);artery occluson pressure: – wedge pressure or filling pressure in pulmonary vasculature when mitral is open PA systolic=20-30 mmHg PA diastolic=5-10 mmHg PAP mean=10-15 mmHg 5-12mmHg

13. Intraradial Intraradial or or Intrafemoral Intrafemoral or or Intrabracial Intrabracial Catheter Catheter Invasive BP Monitoring Via

14.  Hemorrhage  Ischemia  Embolism  Arteriospasm  Infection  Necrosis Complications:

16. 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

17. COMPLICATIONS – Infection – Thrombosis – Digital ischemia – Vessel damage – Bleeding, Necrosis, Hemotoma

18. Arterial pressure monitoring – A-line Pulmonary artery pressure monitoring – PA catheter; Swan-Ganz Right atrial pressure monitoring – RAP, CVP