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Monitoring
Dr. Siti Habibah, SpAn
Defininsi Hemodinamik
O Sistem aliran darah kardiovaskular
Tujuan Pemantauan
Hemodinamik
O Memelihara perfusi organ yang
adekuat
O Flow = (Parterial
Pvenous)/Resistance
O MAP ~ tekanan perfusi
O Autoregulasi
Parameter yang
dipantau
O Preload, kontraktilitas, afterload
(sirkulasi sistemik/pulmonal)
O Siklus jantung: Sistolik dan diastolik
O MAP, CVP, SV, PAP, PCWP
O Curah jantung (CO), CI
O Indeks Tahanan Pembuluh Sistemik (SVRi)
O Indeks Tahanan Pembuluh Pulmonal (PVRi)
O Oksigenasi jaringan: CaO2, DO2, VO2,
O2ER
Hemodynamic
Monitoring
Non Invasive Monitoring
II. Invasive Monitoring
III. Minimally Invasive Monitoring
IV. Monitoring Tissue Perfusion
I.
I. Noninvasive
Monitoring
O NIBP
Invasive Monitoring
Direct Arterial Pressure Monitoring
Indication:
a. Continuous (beat to beat) BP
b. Frequent blood sampling
c. NIBP not possible/reliable
Location:
Radial,brachial,femoral,axillary,dorsalis pedis
Contraindication:
Infection at the cannulation site, lack of
collateral, arterial insufficiency at site, lymphatic
disruption
Hemodynamic
Monitoring
O Interpretation
O Zeroing
O Troubleshooting:
overdamped/underdamped
Complication
O Hematoma
O Catheter related bacterial
colonization
O Local infection
O Bleeding
O Sepsis
O Pseudoaneurysm
O Permanent hand ischemia
Central Venous
Pressure
Indication:
O Measurement of CVP
O Measurement of ScvO2
O Use for pulse wave analysis
O Access for administration of drugs or
parenteral nutrition, intravenous
pacing, PAC
O Intravenous access in patients with
difficult peripheral access
kanan
O Mengetahui volume intravaskular
bila EF>= 40% dan tidak ada
kelainan katup CVP=PCWP
Lokasi Pemasangan
CVC
O Vena antecubital (PICC)
O Vena subclavia
O Vena jugular
O Vena femoral
O Vena brachialis
Interpretation
O A wave: atrial contraction ~ P wave on
ECG
O C wave: early ventricle contaction ~
QRS on ECG
O X descent: downward movement
during contraction ~ before T wave
O V wave: pressure produced when the
blood filling the right atrium ~ T wave
O Y descent: tricuspid valve open
Anomalies and
problems
O Atrial fibrillation absence of a wave
O C wave and x descent is replaced by
Komplikas
i
Pneumothorax
Distritmia
Thrombus/embolism
Hydrothorax
Perdarahan
Infeksi
Pulmonary Artery
Catheter
O Gold standard for cardiac output
determination
O Provide information:
(1) Intrathoracic intravascular
pressure
(2) Cardiac output
(3) SvO2
O Thermodilution technique
Indication
O Differentiation of types of shock
O Assesment of pulmonary edema (ARDS vs
O
O
O
O
cardiogenic)
Diagnosis and monitoring of PH
Diagnosis of cardiac tamponade, pulmonary
embolism, valvular disease
Assessment of hemodynamic response to
therapies
Monitorung and management for patients
with heart failure
Contraindication
O Coagulopathy
O Prosthetic right heart valves
O LBBB
O Right-sided endocarditis
O Poorly controlled dysrhytmias
O Right ventricular thrombus
O Endocardial pacemaker/defibrillator
(relative CI)
Complication
O Pneumothorax
O RBBB
O Dysrhytmias
O Pulmonary artery rupture
O Infection
O Thrombosis
O Endocarditis
O Knotting catheter
PAOP
CO/CI
Distributive shock
Normal/
Cardiogenic
Hypovolemic
Obstructive
Pulmonary embolism
Normal/
Pericardial
tamponade
= CVP
SVR
PA cath location
CVP location
Right
Atrium
A. pulmonalis
pH
Variabel hemodinamik
Variabel hemodinamik
Thank you