Oleh :
Eko Yeppianto,S.Kep.,Ns
HIPERCCI JAWA TIMUR
Sasaran Materi
• Memahami arti dari Monitoring Hemodinamik
• Memahami indikasi Monitoring Hemodinamik
• Fisiologi dasar Hemodinamik
• Macam alat monitor hemodinamik:
• Non invasive
• Semi invasive
• Invasive
– Baik secara continue atau intermitent
• Mampu menginterpretasi hasil monitoring
hemodinamik.
Monitoring Hemodinamik
Definisi Hemodinamik
• Proses dimana darah dialirkan ke seluruh
tubuh.
• Secara spesifik hemodinamik dapat
digambarkan sebagai tekanan intravaskular
dan aliran darah yang terjadi saat otot jantung
berkontraksi dan darah dipompakan ke
seluruh tubuh.
Monitoring Hemodinamik
Pemantauan sirkulasi darah untuk
menjamin deteksi dini adanya
kelainan vital shg kondisi yang lebih
buruk dapat dicegah.
Tujuan Monitoring Hemodinamik :
Volume
PEMANTAUAN HEMODINAMIC
INVASIVE NONINVASIVE
Fisiologi Hemodinamik
SV = Volume sekuncup
HR = Denyut jantung semenit
CO = SV x HR
SV tergantung:
• Preload volume intravaskular
• Kontraktilitas miocard
• Afterload Resistensi sistemik (SVR)
BP = CO x PVR
Patofisiologi
Jenis 2 Monitoring Hemodinamik
• Non Invasive = Asesmen klinis & NIBP, ICON,
USCOM
• Arterial line = pengukuran langsung tekanan
arterial (beat to beat measurement)
• Invasive Hemodinamik monitoring (PA
catheter, CVC, PICCO, LiDCO.
Non Invasive Monitor
• NIBP:
– TD sistolik, TD diastolik & MAP
– Cuff: lebar 2/3 LLA; Panjang + 80% lengan atas.
– Batas bawah cuff + 2,5 cm antecubiti
– Cuff terlalu besar TD terbaca lebih rendah & sebaliknya.
• Pulse oxymetri:
– Pulse rate, amplitudo, SpO2
• ICON:
– SV dll
• USCOM:
– CO, CI
Asesmen klinis penilaian hemodinamik
• Kesadaran
• Nadi, HR
• Mottling
• Temperature
• Capillary refill
• Urine output
METHODS OF CVP MONITORING
• There are two methods of CVP monitoring
– manometer system: enables intermittent readings
and is less accurate than the transducer system
– transducer system:enables continuous readings
which are displayed on a monitor.
Letak insersi CVC
Langkah Pengukuran
1) Levelling ( ICS 4 Mid axilla )
2) Zeroing dan Calibrating
- Close tranducer to patient, Open to atmosfer.
- Press to Zero “0”
- Close tranducer to atm and open to patient.
THE CVP WAVEFORM
The CVP waveform reflects changes in
right atrial pressure during the cardiac
cycle
1. Posisi kepala 0-60 0
2. Jangan diposisikan
lateral
3. Plebostaxis mengikuti
posisi pasien
Gelombang Arterial Line
Damping
Monitoring Hemodinamik Advance
Terminologi:
◦ Preload
◦ Afterload
◦ Cardiac output
◦ Cardiac index
◦ Systemic vascular resistance
◦ Pulmonay vascular resistance
◦ Stroke volume
◦ Pulse Pressure
Noninvasif Invasif
Intermittent Continue
Care of haemodynamic monitoring system
Observe line flush system (q8h)
- Pressure bag inflated to 300 mmHg
- Fluid presence in flush bag
- Flush line is free of air & clots
- Stopcock ports are free of blood/blood
clot
- No stopcock port is left exposed to
atmosfere
Perawatan luka tusukan secara aseptik
Care of arterial pressure line :