Haemodynamic Monitoring & Manipulation: an easy learning guide

Haemodynamic Monitoring and Manipulation

An easy learning guide

Fiona Foxall MA, RGN, ENBIOO, DPSN, BSC, PGCE

Head of Division, Continuing Development,

School of Health, University of Wolverhampton,

West Midlands, UK

With original artwork by Helen Blackburn

Haemodynamic Monitoring and Manipulation: An Easy Learning Guide

Fiona Foxall

ISBN: 978-1-905539-46-8

First published 2009

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M&K Publishing, phone: 01768 773030, fax: 01768 781099 or email: [email protected]

Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

British Library Catalogue in Publication Data

A catalogue record for this book is available from the British Library

Notice:

Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the Publisher. Neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property arising from this publication.

The Publisher

To contact M&K Publishing write to:

M&K Update Ltd • The Old Bakery • St. John’s Street

Keswick • Cumbria CA12 5AS

Tel: 01768 773030 • Fax: 01768 781099

[email protected]

www.mkupdate.co.uk

Designed and typeset in Adobe Garamond 10/12 by S. Maria Hampshire. Cover design by Luke Kelsey.

Printed in England by Reeds Printers, Penrith, Cumbria.

DEDICATION

For Peter:

Sleep peacefully my darling.

Contents

Acknowledgements

Introduction

How to use this workbook

Aims of this workbook

Chapter 1: Physiological maintenance of blood pressure

Chapter 2: Monitoring blood pressure using an arterial line

Chapter 3: Central venous pressure monitoring

Chapter 4: Monitoring and maintenance of cardiac output and tissue perfusion

Chapter 5: The effects of shock

Chapter 6: Use and effects of inotropic and vasoactive agents

Chapter 7: Putting it all together

References

Answers and Teaching Notes

Index

Acknowledgements

Thanks, as always, to Chris, Helen and Matthew Blackburn for all their help and support.

Introduction

The adequacy of the cardiorespiratory system can generally be gauged from basic clinical signs such as heart rate, blood pressure, respiratory rate and depth, skin texture and colour, use of accessory muscles of respiration and mental status. These basic signs should never be ignored, but in critical illness, basic clinical assessment alone may be unreliable and misleading. Therefore further monitoring techniques are usually required.

Appropriate haemodynamic monitoring is essential when caring for the critically ill patient, because it provides very valuable information about the circulatory status of the patient. It aids in early detection of shock and precise diagnosis, guides therapy, and monitors the effects of therapy. Cardiac output and the circulation can be manipulated by fluid and drug administration to ensure good oxygen delivery to the tissues but, in order to do this, ongoing monitoring is required (Jevon and Ewens, 2002).

Many healthcare professionals find it difficult to get to grips with the more complex forms of haemodynamic monitoring and the use of inotropic and vasoactive agents; indeed these things can seem rather daunting. If you work your way through this book and carry out the exercises, you will soon become more confident and competent about haemodynamic monitoring and manipulation as well as understanding all the information that initially seems so complicated.

Here’s to easy learning!

How to use this workbook

It might sound obvious, but you should start at the beginning. Even if you feel quite happy about haemodynamic monitoring, it will be good revision. Steadily work through the material, ensuring you understand the information in each chapter before moving on to the next. Once you have read each chapter, complete the Consolidation section; these will make sure you understand the information sufficiently. Chapter 7 is a bit different from the other chapters; answer the questions and fill in the gaps as you work through the case studies. It will be helpful if you can find a mentor to discuss anything you are unsure about.

If you don’t know a particular answer, try to work it out with the information you have already read. If you still can’t, discuss it with your mentor. If it is still unclear, then look up the answer in the Answer section at the back of the book. If you do look up the answer, make sure you understand it – don’t just accept it. You can talk to your mentor if you have any problems. The Answer section should only be used as a last resort and for checking purposes. It goes without saying that you will learn far more by working things out for yourself than merely reading the explanations provided.

If you already have a reasonable knowledge and understanding of haemodynamic monitoring and manipulation, you could – if you prefer – attempt the Consolidation sections before reading the explanatory text. This will give you a good idea of your current level of knowledge and will also identify any gaps, which you can then concentrate on