Monitoring Hemodinamik

Dasar
Ns. Muhali
Peserta Clinical Perfusionist Training

Pembimbing :
Ns.Heri, S.Kep
 Pemantauan Hemodinamik
• Definisi : Suatu pengukuran terhadap sistem
kardiovaskuler yang dapat dilakukan dengan cara
non invasif atau invasif.

• Berfungsi memberikan informasi mengenai

keadaan :
 Pembuluh darah (after load)
 Jumlah darah (Preload) dalam tubuh dan
 Kemampuan jantung untuk memompakan
darah (kontraktilitas).
(Barbara, 2008)
 PEMANTAUAN HEMODINAMIK

• Adalah pemeriksaan aspek fisik

sirkulasi darah, fungsi jantung dan
karakteristik fisiologis vaskuler
perifer (Mosby 1998, dalam Jevon
dan Ewens 2009)

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 HM : tidak hanya Pencatatan

• TAPI Pemantauan untuk :

 Untuk memonitor dan deteksi dini kondisi
 Untuk membantu perencanaan tindakan
pasien.
 Mengevaluasi segera respon pasien
terhadap intervensi
 Mengevaluasi efektifitas fungsi
kardiovaskuler
 Hemodinamik monitoring

• Bukan TINDAKAN TERAPEUTIK tetapi hanya

memberikan informasi klinis agar dapat
memberikan penanganan yang optimal.
Tujuan
• Menegakkan diagnosis yang tepat,
menentukan terapi yang sesuai, dan
pemantauan respons terhadap terapi yang
diberikan ( Gomersal dan Oh 1997, dalam
Jevon dan Ewens 2009)
• Membantu untuk mengenali syok sedini
mungkin, sehingga dapat dilakukan tindakan
yang tepat terhadap bantuan sirkulasi ( Hinds
dan Watson 1999, dalam Jevon dan Ewens
2009)
Faktor Penentu Hemodinamik
• Preload
• Kontraktilitas
• Afterload
 Metode
Non Invasif
 Hemodynamic monitoring
Non-invasive Invasive
– ECG – Arterial pressure
– Non-invasive blood monitoring
pressure
– Central venous pressure
– Pulse oximetry
monitoring
– Tissue perfusion
• temperature – Pulmonary artery
• Mentation ( BIS, NIRS ) pressure monitoring
– Urine output • cardiac output
– Echocardiogram & • pulse contour cardiac
Doppler output
 Invasif
Arterial line CVC Line
PAC Line/ SwanGanz
 Invasive Pressure Monitor
• Access to an artery or vein
• Catheter connected to fluid filled pressure
tubing & pressure transducer
• Connected to bedside monitor
• Continuous & accurate
• Fluctuation: positional
– Leveling
– Calibration drift
Role of Nurses in Invasive
Hemodynamic Monitoring

• Before insertion
• Insertion
• Post Insertion
 HEMODYNAMIC MONITORING
• NURSING RESPONSIBILITIES
1. Pre-Insertion:
a. Patient & significant others
teaching.
b. Thorough baseline assessment
c. Equipment set-up
d. Positioning of the client
e. Equipment check (calibration, zero
etc.)
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 Before Insertion
Preparing the
equipment
Patient Positioning Informed Consent
Informed Consent Anestesi/Sedasi
NURSING RESPONSIBILITIES
2. Insertion,
(patient is often awake for the
procedure)
a. Collaboration
b. Assist with equipment preparation
c. Monitor patients response to
treatment
e. Recording

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Insertion
NURSING RESPONSIBILITIES

3. Post-Insertion
a. Chest X-ray for placement
b. Sterile OCCLUSIVE dressing, stabilization
of the catheter
c. Patient comfort
d. Assess and document pressures/data
e. Catheter maintenance
f. Monitor patients response

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 Post Insertion
Smoothed patient and tools Documentation
NURSING RESPONSIBILITIES

• Maintenance of the System:

a. Label and date lines, change tubing as per
unit policy
b. Maintain & change dressing
c. Alert for waveform and pressure changes
d. Maintain pressure/pressure bag
e. Keep balloon deflated between PCWP
readings
f. Collaboration and communication with
physician
g. Remember to care for the patient as well as
your equipment

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 HEMODYNAMIC
MONITORING
• POTENTIAL COMPLICATIONS
1. Dysrhythmias
2. Infection
3. Pneumothorax
4. Pulmonary infarction
5. Balloon rupture and air embolism
6. Pulmonary artery rupture
7. Endocarditis

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• TYPES OF CATHETERS USED FOR
HEMODYNAMIC MONITORING:
•
1. Arterial Pressure Catheters

2. Central venous Pressure or CVP

monitoring

3. Pulmonary Artery Catheter or

SwanGanz Catheter

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 ARTERIAL PRESSURE
MONITORING:
1. Indications
2. Assessment data:
* MAP = (diastolic x 2)+(systolic)
3

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Arterial Line
• ARTERIAL PRESSURE MONITORING:

3. Arterial Waveform
a. Aortic valve opens and blood is ejected
from LV and is recorded as an increase in
pressure

b. Highest point represents systole

c. Lowest point is diastolic pressure

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• ARTERIAL PRESSURE MONITORING:

• 4. Nursing Responsibilities
• 5. Potential Complications:
a. Thrombosis at catheter tip
b. Infection
c. Bleeding
d. Loss of flow distal to extremity

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 Nursing Responsibilities
• Prepare the setup and the circuits
• Assist in the procedure
• Caring for equipments as well as for the
patient.
• Calibration
• Obtaining the readings
• Interpreting the results and informing the
physician
• Providing the suitable management
• Documenting
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Central Venous Pressure (CVP)
• Nursing Responsibilities ( the same with
PAC cath )

• Potensial Complication
- Infection - Catheter occlution
- Pneumothorax - Catheter displacement
- Air Emboli
- Haemorrhage
Catheter CVC
Posisi Kateter
Monitoring CVP system with
water manometer

Manometer
Using Manometer
Monitoring system with
transducer
Preparing tools

Transducer
 Pulmonary Artery Monitoring
Equipment

1. Invasive catheter (swan ganz)

2. Transducer

3. Amplifier/recorder

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 HEMODYNAMIC MONITORING
• SWAN GANZ CATHETER

a. Distal Lumen: the PA (pulmonary artery)

b. Proximal Lumen: (CVP port)
c. Inflation Balloon
D. Thermostat Lumen
e. Additional Lumens
* VIP - venous infusion port
* Pacing Port

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Catheter Swanganz
Kateter Cavafix
Area Penusukan
 Cardiac Output
• It is the amount of blood pumped by the heart in
one minute.
• Calculated by multiplying heart rate times stroke
volume.
• Cardiac Index is the cardiac output adjusted for
body surface area.
Plebostatic axis
Levelling and zero balance
Waveforms
Arterial Pressure Waveform
Underdamped arterial line
waveform
Overdamped arterial line
waveform
Normally damped arterial line
waveform
CVP waveform
Overwedging waveform
TROUBLE SHOOTING

• Equipment
• Setting
• Human error
1.BIS

2. NIRS
 BIS
• BIS monitoring
- Salah satu alat yang digunakan untuk
memantau kedalaman anestesi

- BIS berbasis pada statistik empiris

parameter dan merupakan kalkulasi dari
subparameter EEG meliputi waktu, domain,
domain frekuensi dan spektrum tinggi
Monitor BIS
BIS value range
BIS Quatro
 Cerebral Oximetry
• Alat pemantauan oksigenasi cerebral secara
non invasive dengan menggunakan prinsip
kerja NIRS
• Tehnologi NIRS berdasarkan penyerapan
gelombang cahaya
• Rentang panjang gelombang near-infrared
( 650-940 nm )
MONITOR NIRS
Probe NIRS
Algorithm NIRS
TROUBLE SHOOTING

• Equipment
• Setting
• Human error