Pendahuluan
Panduan Resusitasi
Hemodinamik
SISTEMIK
SISTEMIK/ SVRI
SIRKULASI TAHANAN
PULMONER/ PVRI
KELUAR
PULMONER
MAP/ MPAP
TEKANAN
KEDALAM
PAOP/ CVP
Aorta
Lung
Left Pulmonal
Pulmonal artery
atrium vein
SVR =
Right Systemic
Atrium Left
ventricle Vascular
Resistance
Right
ventricle
organ
Komponen Hemodinamik
Blood Pressure (BP)/TD
Central Venous Pressure (CVP)
Right and Left Heart Pressures
WHY?
Untuk optimalisasi konsumsi oksigen & metabolisme
Dan ketersediaan energi
HOW?
Monitoring tekanan arterial
A-line
Monitoring tekanan arteri pulmonalis
PA catheter; “Swan Ganz”
Monitoring tekanan atrium kanan
RAP; CVP
KRITERIA HEMODINAMIK YG
MEMERLUKAN MONITORING KETAT
ALIRAN
TEKANAN
ALIRAN =
TAHANAN
VASOCONSTRICTION:
Angiotensin II, ADH, Adrenaline,
NorEphinephrine, Metaraminol
ALIRAN
TEKANAN
ALIRAN =
TAHANAN
ALIRAN
OBSTRUCTION:
Trombus, sclerotic
TEKANAN VASODILATATION:
Nitroglyserine,
ALIRAN = Nitroppruside,
TAHANAN milrinone, dobutamine
Cardiac Output (curah jantung)
CO = HR X SV
SV = Preload, afterload, dan
contractility
Preload
Regangan serabut otot sebelum sistole
(volume dalam ruang jantung pada ahir
diastole)
Ditentukan oleh LVEDV/LVEDP
Hukum Starling’s
Regangan ↑= volume ↑
(regangan berada dalam batas normal)
Preload/Afterload in Heart
Afterload
Inotropes
Vasopressor
Volume =
Blood
Hypovolemic
Fluids Shock
Komponen Monitoring Hemodinamik
Transducer
• Merubah peristiwa2 fisiologis kedalam
sinyal2 elektrik (e.g. tekanan,
temperatur, cahaya)
Amplifier
• Menangkap sinyal elektrik dan
mentransmisikan kelayar monitor
Components of Hemodynamic
Monitoring
Monitor Display
• Layar monitor (gambaran gelombang,
nilai pressure)
Catheter tubing / flush system
• Perawatan kateter
• Pressure bag
Reliable Measurements
Interval penilaian
• Manual : 15 menit
• NIBP : 3 menit
• Intra-arterial/invasive : real time/kontinyu
Intraarterial Monitoring
Indikasi
Monitoring kontinyu tekanan darah
Blood sampling
p↑an tek. Intrakranial
Obat vasoaktive
Sites
Radial
Brachial
Femoral
Allen Test
Nursing interventions
RV preload/RVEDP
Right pressure changes usually occur
late
Kateter untuk menilai RAP
Pulmonary artery catheter (proximal port)
Central line (e.g. triple lumen catheter)
Peripherally inserted central catheter
(PICC) line
Measurement
Zero/level/balance
• Positioning patient
• Respiratory cycle
Interpretasi Nilai CVP
Pneumo/hemothorax
Perforasi jantung
Disritmia
Zero/balance
Analisa gelombang
Variasi Respirasi
Monitor komplikasi Infeksi
Central Venous Pressure
TRIPPLE LUMEN CATHETER
16 Ga
18 Ga 18 Ga
INTERPRETATION
Kateter Arteri Pulmonalis
1970
Dr. Swan and Ganz (Swan-Ganz is a brand)
Menggambarkan tekanan pada jantung
kiri
Description
Balloon-tipped
Measures PA systolic, diastolic,
mean, and wedge (PCWP; PAWP;
PAOP)
Multi-lumen
Proximal (RA)
Proximal injectate
Distal (PA)
Balloon
Insertion
Right A. pulmonalis
Atrium
Interpretation
Infection
Dysrhythmias
Air embolus
Thromboembolism
PA rupture
Pulmonary infarction