(精选)【持续性肾脏替代治疗CRRT英文精品课件】Hemodynamic Monitoring and Transthoracic Lines教学课件.pptVIP

Hemodynamic Monitoring and Transthoracic Lines;Infants and children undergoing open heart surgery may require intracardiac monitoring. The hemodynamic data can assist in the assessment of contractility, preload and afterload. As the patient stabilizes post cardiac by-pass, intracardiac catheters (RA) may be left in place for vascular access reasons.;What’s the difference ?? “Percutaneous” vs “Transthoracic”;Examples of Percutaneous lines: PICCs Tunneled lines Non-tunneled lines Swan-Ganz thermodilutional catheters Dialysis/CRRT catheters;Examples of Transthoracic Lines;;Hemodynamic Waveforms- Normal Heart;Right Atrial Pressure MonitoringIndications;Right Atrial Pressure MonitoringWaveform Analysis;Right Atrial Pressure MonitoringWaveform Analysis;Elevated systemic ventricular end diastolic pressure mitral valve disease Large left-to-right shunt intravascular volume overload cardiac tamponade tachyarrhythmia Artifactual ; low intravascular fluid status Inadequate preload Artifactual ;Reasons for elevated PA pressure: ;Nursing HOURLY assessment: Air in line or stopcocks Precipitates Leaking at site Increasing resistance Condition of entrance sites; Check coagulation labs (pt, ptt, INR, platelets) Transfuse if Platelets than 70 and INR 1.5 Ensure Packed Red Blood Cells in cooler at bedside (Remember two RN check for PRBCs. Instructions for blood in cooler, taped to cooler) Ensure good vascular access Ensure chest tube patency Evaluate need for sedation. (if too active ↑ BP may → bleeding) ;After Removal of Transthoracic Line;Pressure Line Safety;References