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

2. 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

3. 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

4. Cardiac Output CO SV
Preload
Afterload
Contractility HR X

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

6. 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 – L/min
Cardiac Index
Cardiac output divided by body surface area
CI – L/min/m2

7. 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

8. 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

9. 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

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

11. 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

12. 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

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

14. 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

15. 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

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

17. 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

18. 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