Ibp,pac,cvp

Invasive blood pressure, pulmonary artery catheter, central venous catheter

1. Hemodynamic Monitoring NIBP,IBP,CVP,PAC Presenter-Dr. Ranjeet Bihari MD Anesthesia Pdcc Neuroanesthesia

2. I ntroduction Critically ill patients require continuos assessment of their cardiovascular system to diagnose and manage their complex medical conditions . This is most commonly achieved by the use of direct pressure monitoring systems,often refered to as hemodynamic monitoring. Heart function is the main focus of hemodynamic studies . Hemodynamic pressure monitoring provides information about blood volume , fluid balance and how well the heart is pumping

3. Monitoring system component 1-biological variable 2-Sensor 3-Integrator( static and dynamic caliberation ) 4-Out put( displaying the information in waves and digital form)

4. Invasive Blood pressure

5. Biological variable In this arterial blood pressure is measured invasively

6. Zeroing and leveling Zeroing is done by exposing the transducer to atmospheric pressure and calibrating the pressure reading to zero Is any relation between zeroing and leveling???

7. PHLEBOSTATI C AXIS

8. Work of strain gauge

9. Modern wheat stone bridge

10. Integrator This is done by the computer. For this there is need of the caliberation Two types of caliberation

11. 1-Resonance

12. Q uestion Which parmeter does not effected by the dmping ?

13. Answer . A monitoring system with too low a frequency response (over-dampened and a depressed waveform) or a high frequency response (under-dampened and a rather vibrant waveform) will result in underestimation or overestimation, respectively, of the arterial pulse pressure without altering the accuracy of reporting the mean arterial pressure (MAP)

14. Physilogical basis of arterial waveform

15. Arteria pressure

16. Distal arterial tree amplification MAP remains constant 60 ms delay in the aortic up stroke and its peripheral counterpart

17. Out come:: normal graph

18. Derived parameters of the arterial wave forms It is created by this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance , and during positive-pressure breathing, SV variation, and pulse pressure variation

19. By this pulse pressure profile. These include estimates of left ventricular stroke volume (SV), CO, vascular resistance, and during positive-pressure breathing, SV variation, and pulse pressure variation (PPV)

20. contractility This is dp / dt ;quicker rise ---more dp / dt —more contractility

21. Central arterial compliance Older the person lesser the arterial compliance; greater pulse pressure Younger the person more the arterial compliance; lessar pulse pressure

22. Peripheral vascular resistance When SV is stable and/or fixed, changes in vascular resistance will manifest as changes in the downslope of the arterial waveform. If the arterial waveform downstroke sharply decreases, as often is the case with vasodilator therapy or sepsis, there is little resistance to blood flow . If the downstroke of the arterial waveform is rather shallow, as is often in the case of severe heart failure, then this indicates a higher resistance

23. H ypovolumia . Hypovolemia will cause a large increase in the variation of both systolic pressure and pulse pressure compared to normovolemic states . Large systolic pressure or PPVs are correlated with lower amounts of intrathoracic blood volume and ventricular filling pressures

24. Questation & Answer

25. What are the main components of an intra-arterial blood pressure measuring system ?

26. . Why should an intra-arterial blood pressure measurement system have a high natural frequency?

27. Why should a pressure transducer be positioned at the same level as the patient’s heart? .

28. What features of an intra-arterial blood pressure measurement system help to reduce errors from excessive damping

29. Tubing should be – Stiff &low compliance Stiff and high compliance Only stiff