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Cardiac Output Monitoring

The document describes the thermodilution method for measuring cardiac output. It involves injecting a cold saline solution into the heart and measuring the change in temperature over time in the pulmonary artery to calculate cardiac output. It also discusses measuring cardiac index, mixed venous oxygen saturation, inserting and maintaining arterial lines, and potential complications.

Uploaded by

maj
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
336 views

Cardiac Output Monitoring

The document describes the thermodilution method for measuring cardiac output. It involves injecting a cold saline solution into the heart and measuring the change in temperature over time in the pulmonary artery to calculate cardiac output. It also discusses measuring cardiac index, mixed venous oxygen saturation, inserting and maintaining arterial lines, and potential complications.

Uploaded by

maj
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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CARDIAC OUTPUT

MEASUREMENT
(Thermodilution Method)
CARDIAC OUTPUT
MEASUREMENT
Procedure:

1. Position: Supine with head elevated at


30º angle.
2. The injectant (5-10 ml NSS) must be
delivered within 4 seconds on the
proximal lumen.
CARDIAC OUTPUT
MEASUREMENT
Procedure:
3. The injectant is delivered at same point
at the end of exhalation.
Note: • Three (3) cardiac output
measurements within a 10% mean range
are calculated and averaged.
• The difference between the injectant &
body temperature is at least 10ºC.
Cardiac Output
Waveforms
CARDIAC INDEX
MEASUREMENT
CARDIAC INDEX
MEASUREMENT

Cardiac Index = Cardiac Output / Body

Surface Area

Normal Value : 2.2 - 4.0 L/m / m²


Body Surface Area
MIXED VENOUS
OXYGEN
SATURATION
(SVO2)
Mixed Venous Oxygen
Saturation (SVO2)

Metabolic tissue
Oxygen Supply demand
Mixed Venous Oxygen
Saturation
 Normal Value : 60% - 80%

 Below 60%
 Causes:
• Low hemoglobin
• Hypoxemia
• Low Cardiac Output
• Increased Oxygen Consumption
Mixed Venous Oxygen
Saturation

 High SVO2

 Causes:
• Increased O2 supply
• Decreased O2 supply
ARTERIAL LINE
ARTERIAL LINE

I. Purposes:

1. Continuous BP reading
2. Access for withdrawal of blood
samples.
3. Measurement of cardiac output
ARTERIAL LINE
II. Indications:

1. Complicated surgeries
2. Multiple peripheral vascular disease
3. Respiratory ailments/prolonged
weaning from mechanical ventilation
ARTERIAL LINE

II. Indications:

4. Vasoactive / antihypertensive
medications
5. Extensive burns / multiple trauma
6. Morbid obesity
ARTERIAL LINE
III. Sites of Cannulation

 radial
 brachial
 femoral
 dorsalis pedis
ARTERIAL LINE

III. Sites of Cannulation

 Considerations:
1. (+) well-pulsating & readily
cannulated artery
2. (+) collateral circulation to the
involved artery
ARTERIAL LINE
IV. Equipment/Supplies
 Pressure bag  Monitoring line
 Transducer
 Monitor w/ A-line
 Infusion set
amplifier  10 cc syringe
 IV catheter  3-way stopcock
 NSS with Heparin  cotton balls
 Critiflo / Infraflo
 adhesive tape
 alcohol
 4 x 4 gauze
ARTERIAL LINE

V. Nursing Responsibilities

1. Assemble equipment
2. Explain procedure
3. Skin preparation / strict asepsis
4. Monitor arterial blood pressure
V. Nursing Responsibilities
5. Troubleshooting arterial
line problems
PROBLEM PREVENTION TROUBLESHOOTING

Damped waveform - continuous infusion - complete flushing


of heparinized of tubing
solution
V. Nursing Responsibilities
5. Troubleshooting arterial
line problems
PROBLEM PREVENTION TROUBLESHOOTING

Loss of waveform - quick monitoring - ensure line patency


- change patient’s
position frequently.
V. Nursing Responsibilities
6. Prevent Complications
PROBLEM PREVENTION TROUBLESHOOTING

Hemorrhage - Use luer- - tighten all


locks connections
- Close / cap - provide splint
stopcocks - flush line
- Secure / suture - estimate blood
catheters loss
- if catheter is
removed, apply
pressure & sterile
dressing
V. Nursing Responsibilities
6. Prevent Complications

PROBLEM PREVENTION TROUBLESHOOTING

Clot formation - continuous - Aspirate the line


infusion of then flush when
heparinized clot is removed
solution

Air embolism - purge air bubbles - vent bubbles


(catheter, IVF bag, through the
drip chamber) stopcocks
- fill drip chamber
V. Nursing Responsibilities
6. Prevent Complications

PROBLEM PREVENTION TROUBLESHOOTING

Infection - change IVF - Hand washing


solution every 4 - observation of
hours; line set-up infection control
and disposable protocols.
transducer every
72 hours.
- Daily dressing &
site inspection

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