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Hemodynamic

Monitoring
Dr. Siti Habibah, SpAn

Defininsi Hemodinamik
O Sistem aliran darah kardiovaskular

yang memperlihatkan sistem kerja


kardiovaskular (jantung dan
pembuluh darah)

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

1. Prinsip kerja: suara korotkoff


(manual)/
oscillatory (automated)
2. Nilai MAP lebih berguna
3. Lebih rendah dari invasive
4. Penting ukuran cuff
O ECG continuous, pulse oxymetry, UO,
core body temperature

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

Tujuan klinis CVP


O Menginformasikan fungsi jantung

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

End Tip CVC on CXR

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

large positive wave of tricuspid


regurgitation
O Not accurate predict of fluid
responsiveness
O Impaired RV function, severe
pulmonary disease, valvular disease
affect the CVP reading

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

Interpretation of PAC findings


Condition/Type of
Shock

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

III. Minimally invasive


Monitoring
1.
2.
3.
4.

CO2 rebreathing (NiCCO)


Pulse wave analysis (LiDCO)
Esophageal doppler
Plethysmography/thoracic electrical
bioimpedance
5.Echocardiography
6. Arterial pressure waveform analysis
7. Systolic Pulse Contour Analysis with
Transpulmonary Thermodilution calibration
(PiCCO)

IV. Monitoring tissue perfusion


O Metabolic acidemia
O Serum lactate
O SvO2
O Gastric mucosal pH ~ intracellular

pH

Variabel hemodinamik

Variabel hemodinamik

Thank you

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