CRITICAL CARE SKILLS SERIES
HEMODYNAMIC MONITORING

Up Schedule Objectives Faculty


OBJECTIVES

List all the hemodynamic parameters that can be monitored with a CCO thermodilution pulmonary artery catheter.

Recognize normal waveforms encountered in pulmonary artery catheterization.

List causes of abnormal pulmonary artery diastolic pressure (PAD) and pulmonary artery wedge pressure (PAWP).

List the nurse's role in troubleshooting problems encountered during pulmonary artery pressure monitoring.

Explain respiratory variation when referring to PA pressure readings.

Discuss the issues regarding patient positioning during both PAP monitoring and arterial pressure monitoring.

Describe the proper technique for inflating and deflating the balloon on a PA catheter.

Explain the rationale for inserting a pacing catheter if the patient has a pre-existing left bundle branch block.

Identify measures that can decrease the likelihood of balloon rupture on a PA catheter.

Discuss the rationale for reading the mean of the "a" wave when obtaining a PAWP in certain patients.

Explain why the PAWP should not be higher than the PA diastolic pressure.

Describe the pulmonary artery changes consistent with the following conditions:

- Hypovolemic shock
- Cardiogenic shock
- Cardiac tamponade
- Septic shock
- Right ventricular MI

Differentiate the lumens on a triple lumen central venous catheter and identify the preferred lumen for central venous pressure (CVP) monitoring, blood sampling, and administration of high volume or viscous solutions.

Explain the technique for obtaining a CVP reading from a right atrial pressure waveform.

Discuss current opinions regarding use of central venous catheter for analysis of central venous oxygen saturation.

Discuss the following aspects of nursing management of a central venous catheter:

- Verification of patency
- Maintaining patency of a saline-locked lumen
- Obtaining a blood sample
- Steps to minimize catheter-related infections

Define "dead space volume" as it relates to the central venous catheter.

State the anatomical landmark for leveling the air-fluid interface of the transducer for arterial pressure monitoring.

Compare characteristics of a normal arterial waveform and an overdamped arterial waveform.

Discuss the use of the square wave test in assessment of the arterial line.

Describe ways to troubleshoot an overdamped arterial pressure waveform.

Explain the steps to troubleshoot a discrepancy between arterial line blood pressure and cuff blood pressure.

Explain the physiologic rationale for SvO2 monitoring.
 

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