Prepared by : Monirah Al-Bloushi 2007

Monirah Albloshi

Blood pressure BP Systolic blood pressure SBP Diastolic blood pressure DBP Mean arterial pressure MAP Central venous pressure CVP Pulmonary artery wedge pressure PAWP
Monirah Albloshi

BLOOD PRESSURE
Blood pressure is a measurement of the force applied to the walls of the arteries as the heart pumps blood throughout the body. Blood pressure is determined by the strength of contraction, amount of blood pumped into the arteries, the viscosity of the blood, and the size and flexibility of the arteries.

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SYSTOLIC BLOOD PRESSURE

Maximimal pressure within the arterial vessels following ventricular ejection During ventricular ejection (SBP) pressure in the aorta

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DIASTOLIC BLOOD PRESSURE

Minimal pressure within the arterial vessels following ventricular resting state or diastole Average DBP in healthy adult is 80 mmHg both SBP & DBP are affected by cardiac output & total peripheral resistance.

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MEAN BLOOD PRESSURE

MAP= CO Total peripheral resistance. MAP is estimated by adding the diastolic pressure to 1/3 pulse pressure Pulse pressure is the different between SBP and DBP MAP=SBP+DBP2 3
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IMPORTANT OF MEASURING MAP

MAP may be more sensitive indicator for acute changes within the arterial system. Systolic blood pressure differ within the central and peripheral circulation but the MAP and DBP don't changes MAP is more accurate In patient with vasoconstriction, shock, hyperthermia, stenosis, vasodilator therapy, cardiac by pass
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ARTERIAL LINE
An arterial line is a thin catheter inserted into an artery. It is most commonly used in ICU An arterial line is usually inserted in the wrist (radial artery), armpit (axillary artery), groin (femoral artery), or foot (pedal artery).

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ARTERIAL LINE-INDICATION
Monitoring patients with unstable hemodynamic status or respiratory status frequent blood sampling

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ARTERIAL LINE VS NBP CUFF

Both It measure blood pressure in different way NBP record the flow of the blood in the artery Arterial line measure the pressure in the artery
Monirah Albloshi

 Obtain a complete medical history of DM, HTN, peripheral vascular disease ,CABG,AV fistula, Assess patient medical history of coagulpathies, use of anticoagulant, vascular abnormalities. Assess patient allergic reaction Assess the site for presence of strong pulse
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ARTERIAL LINE PATIENT ASSESSMENT PREINSERTION

ARTERIAL LINE-POST INSERTION

Observe the insertion site for sign of hemostaisis after the procedure Observe the insertion site and involved extremities for sings of neurovascular complication Observe the insertion site for local infection
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LEVELING & ZEROING THE ARTERIAL LINE TRANSDUCER

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ARTERIAL LINE COMPLICATIONS

Pain ,vasospasm, hematoma formation, infection, hemorrhage and neurovascular compromise

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CENTRAL LINE SITES

The most commonly used veins are the internal jugular vein, subclavian vein and the femoral vein. this is in contrast to a peripheral line which is usually placed in the arms or hands.
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Monirah Albloshi

CENTRAL LINE -INDICATIONS

Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid balance Parenteral nutrition Drugs that are prone to cause phlebitis in peripheral veins (caustic), such as:
Calcium chloride Chemotherapy Potassium chloride Amiodarone

Need for intravenous therapy when peripheral venous access is impossible

Blood Medication Rehydration
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CENTRAL VENOUS LINE CHANGES

Increased CVP
Elevated fluid level cardiac out put right ventricular failure preicarditis Pulmonary hypertension Chronic heart failure

Decrease CVP
Reduce vascular volume vasodilatation Decrease systemic pressure (shock)

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CENTRAL LINE ADVANTAGES

High blood flow to the superior vena cava promote rapid dilution of the fluid which decrease the risk of inflammation and thrombosis that occur in the central line. Stable access for the venous system risk of infiltration and tissue damage CVC may shorter hospital stay by access to treatment as an outpatient Physical and psychological damage of repeating IV puncture

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CENTRAL LINE COMPLICATION

Bleeding Hematoma Malpostion of the tip Pneumothorax Nerve injury Dysrhythmias Air embolism
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PULMONARY ARTERY CATHETER SWAN GANZ

Is used to determine hemodynamic status in critically ill patients PA catheter provide information about right and left intracardiac pressure and cardiac output Monitor of mixed ventricular volumes and ejection fraction Hemodynamic information obtained from PA help to administer fluid and medication according to patients need
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Monirah Albloshi

INDICATION
Management of complicated myocardial infarction Assessment of respiratory distress Assessment of type of shock Assessment of therapy
Afterload reduction Vasopressors Beta blockers Intra-aortic balloon pump

Assessment of fluid requirement in critically ill patients Management of postoperative open heart surgical patients Assessment of valvular heart disease Assessment of cardiac tamponade / constriction
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CARDIAC OUTPUT
Cardiac output is the volume of blood being pumped by the heart in particular a ventricle in a minute. It is equal to the heart rate multiplied by the stroke volume. Therefore, if there are 70 beats per minute, and 70 ml blood is ejected with each beat of the heart, the cardiac output is 4900 ml/minute. This value is typical for an average adult at rest, although cardiac output may reach up to 30 liters/minute during extreme exercise. A parameter that is related to stroke volume is Ejection Fraction (EF). EF is the fraction of blood ejected by the Left Ventricle (LV) during the contraction phase of the cardiac cycle (known as Systole). At the start of Systole, the Left Ventricle is filled with blood to the extent known as EDV (End Diastolic Volume). During Systole, the LV contracts and ejects blood until it reaches it's minimum volume known as ESV (End Systolic Volume. Stroke Volume (SV) = EDV ESV Ejection Fraction (EF) = (SV / EDV) 100 Cardiac Output (CO) = SV HR Cardiac Index) CI) = CO / BSA = SV HR/BSA HR is Heart Rate, expressed as BPM (Beats Per Minute (BSA is Body Surface Area in square metres) Monirah Albloshi

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COMPLICATIONS
The procedure is not without risk, and complications can be life threatening. arrhythmias pulmonary artery can lead to pneumothorax infection thrombosis and other problems bleeding

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