1. BY: OTEWA, MESHACK OPONDO, EDDAH
TECHNOLOGY USE TO ENHANCE QUALITY CARE: INVASIVE BLOOD PRESSURE MONITORING
BY:
OTEWA, MESHACK
OPONDO, EDDAH

2. METHODS OF MEASURING BLOOD PRESSURE
NON-INVASIVE BLOOD PRESSURE MONITORING
This consists of use of an inflatable cuff and a measuring scale may either be mercury filled or a digital scale.

3. INVASIVE BLOOD PRESSURE MONITORING
The components include the measuring apparatus, the transducer and the monitor.

4. THE NORMAL WAVEFORM FOR AN INVASIVE ABP:
Initial sharp rise ( Left ventricular systole)
Rounded slope (Peak systolic pressure)
Dicrotic notch (Closure of the aortic valve)
Descending slope (Beginning of diastole

5. PHYSICAL PRINCIPLES OF IABP MEASUREMENT
1.Natural Frequency and resonance: quantifies how rapidly the system oscillates.

6. PHYSICAL PRINCIPLES OF IABP MEASUREMENT
2. Damping Coefficient: quantifies the frictional forces that act on the system and determines how rapidly it comes to rest.

7. PHYSICAL PRINCIPLES OF IABP MEASUREMENT
3. Transducers levelling and zeroing

8. DAMPING COEFFIECIENT Critical-Damping Over- Damping Under-Damping
Optimal Damping

9. DAMPING COEFFICIENT

10. ABNORMAL ARTERIAL PRESSURE WAVEFORMS

11. CASE STUDY
Patient A.O.K being managed for sepsis has come with a BP of 78/55; a decision is made by the multidisciplinary team to start the patient on a vasopressor (Norepinephrine 10-15mcgs/min).

12. CASE STUDY CONT’
The patient is then started on Noradrenaline and is now due for monitoring of the BP as the nurse titrates the dose. IBP is initiated whilst the inotropic support is initiated. The monitoring was more effective as the BPs fluctuated and made it easier for the nurse to monitor the BP.

13. ADVANTAGES It allows ‘beat-by-beat’ BP monitoring.
It allows accurate BP readings at low pressure and in patients with arrythmias
Improvement of patients comfort in long term monitoring.
Indwelling catheter is convenient for repeated arterial blood sampling

14. ADVANTAGES
The waveforms produced maybe analysed, allowing further information about the patients’ cardiovascular status.

15. DISADVANTAGES
Hematomas
Thrombosis
Infection
Arterial injuries

16. SUMMARY
IABP monitoring is a highly useful tool, which offering beat-to beat blood pressure measurement and a visible waveform, allowing a more detailed analysis of the patients’ cardiovascular status to be made.

17. SUMMARY CONT’
However, an awareness and understanding of the common sources of error – primarily resonance, damping and errors of zeroing and levelling- and how to detect and prevent these errors is important to ensure an accurate and useful measurement is made.

18. FURTHER READING
1. Magee P, Tooley M. The physics, clinical measurement of anesthetic practice. Oxford University Press Ward M, Langton J. Blood Pressure Measurement. Continuing Education in Anaethesia, Critical care and Pain 2007 Vol 7 (4):

19. FURTHER READING CONT’
3. Stoker M. Principle of pressure transducers, resonance, damping and frequency response. Anaesthesia and Intensive Care Medicine (11): Gupta B. Invasive blood pressure monitoring. World Anaesthesia Society, Update m_docman&task- doc_download&gid=210&Itemid=26

20. QUESTIONS