HAEMODYNAMIC MONITORING SETUP IN THE CATHETERISATION LABORATORY MAHAT SAPION

HAEMODYNAMIC MONITORING SETUP IN THE CATHETERISATION LABORATORY MAHAT SAPION

Haemodynamic Monitoring

Functions of monitoring to detect that there is a problem blood pressure compensatory sympathetic stimulation organ dysfunction tissue hypoxia to give information to allow diagnosis of the problem

Pressure and Pascal s Law Hale s report/observation = Pressure wave variations to >/< degree by the plumbing system before reaching transducer distorted waveform faithfully reproduced by electronic system

Haemodynamic Monitoring the yester years Amplifiers/Junction boxes Plumbing system Recorders Monitors Materials

Pressure Measurement Hydrodynamic pressure: Static/residual Dynamic pressure Static pressure head

Guidelines For Use of Pressure Measurement System materials selection equipment checks setup procedure care & maintenance

Component of the fluid filled system

Material selection Flush solution Pressure for flush solution Solution administration set Rate control Stopcocks/manifolds Extension tubings Pressure Transducer/domes

Stopcocks

Reusable transducers Highly accurate and robust piezoelectric crystal Dry connection from dome to sensor Pre-calibrated sensor of high accuracy Overload protection Can be used with all CF Class monitors

Disposable transducer Compact and 100% tested for excellent pressure transmission Modern chip technology for accurate registration of values Pre-calibrated sensor with constant electric parameter Optimised fluid channel for easy bubble-free filling.

Haemodynamic setup Components of the electrical system

Equipment checks Assessment for reliability & safety of instrument before initiating pressure monitoring Instruments and transducers

Set-up procedure Prepare instrument/equipment Assemble flush system Check electrical and transducer calibration Check monitors and recorder

Calibration Zeroing catheter-tubing-transducer system - To establish atmospheric pressure as zero - To compensate for hydrostatic effect of fluid in the system - Ensures only pressures within the vessels or heart chambers are measured.

REFERENCE POSITION PHLEBOSTATIC AXIS AIR - FLUID INTERFACE PART OF CATH-TRANSDUCER- TUBING IS MAINTAINED AS REFERENCE POSITION STD. REFERENCE POSITION IN SUPINE POSITION IS PHLEBOSTATIC AXIS - PHLEBOSTATIC AXIS = THE JUNCTION OF TRANSVERS PLANE: 4 TH ICS ADJESCENT TO STERNUM AND FRONTAL PLANE: OUTERMOST SURFACES OF THE A/P CHEST. - MID-CHEST REF. POINT & MID-AXILLARY POINT ARE DIFFERENT IN LARGE PATIENTS AND IN ASYMMETRICA CHEST.

Leveling to the Phlebostatic Axis Air-fluid interface of zeroing stopcock is positioned to the phlebostatic position. - Higher zero position = falsely low due to decrease hydrostatic pressure. - Lower position = higher pressure due to increase in hydrostatic pressure - Every 1cm zero level is above /below actual level = +/- 0.74mmHg

Pressure trace

Pressure waveforms Underdamped all frequency components are transmitted without reduction in amplitude >> overestimation of systolic pressure. Overdamped amplitude reduction of some of major components of the transmitted pressure >> underestimates SP and overestimates DP Critical damping resonant frequency of cath/transducer are without attenuation or accentuation of pressure signal

Optimising Dynamic Response Characteristics Optimal dynamic response: 2/3 rapid oscillations from top to bottom of pressure tracing followed by return to the baseline waveform pattern. Underdamped response: > 3 oscillations, causing ringing in pressure waveforms. Overdamped response: blunting of square wave pattern with loss of oscillation

After Use Equipment Care Care of transducer Correct and proper storage

.... what say u? Haemodynamic monitoring includes all vital parameters that bring wellness to the patient. The clinician has the conceptual clinical understanding, the limitations of the monitoring system and the effects of the various elements. The competency of the technician attributes to the resultant patient management.