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The adequacy of the cardio respiratory system can generally be gauged from basic clinical signs such as heart rate, blood pressure, respiratory rate and depth, skin texture and colour, use of accessory muscles of respiration and mental status. These basic signs should never be ignored, but in critical illness, basic clinical assessment alone may be unreliable and misleading. Therefore further monitoring techniques are usually required. Cardiac output and the circulation can be manipulated by fluid and drug administration to ensure good oxygen delivery to the tissues but in order to do this, ongoing monitoring is required. Many healthcare professionals find it difficult to get to grips with the more complex forms of haemodynamic monitoring and the use of inotropic and vasoactive agents; indeed these things can seem rather daunting. If you work your way through this book and carry out the exercises, you will soon become more confident and competent about haemodynamic monitoring and manipulation as well as understanding all the information that initially seems so complicated. Here s to easy learning!

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Médecine

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Publié par	M&K Publishing
Date de parution	01 mars 2009
Nombre de lectures	0
EAN13	9781907830464
Langue	English

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Haemodynamic Monitoring and Manipulation
An easy learning guide
Easy Learning Guides from M K
The array of complex functions carried out by senior clinical staff can be quite bewildering to more junior staff. Some of them would like to wave a magic wand that makes them instantly knowledgeable and confident. These Easy Learning Guides are not a magic wand, but they are probably the next best thing! They were written by a health professional who had to learn by experience, along with everyone else, but who knows that there are far easier ways to pick up these essential skills.
These no-fuss practical guides promote confidence and competence in several key areas of clinical practice, including:
Artificial Ventilation
Arterial Blood Gas Analysis
Cardiac Arrhythmia Recognition
Fluid Electrolyte Balance Control
Neurological Observations Their Significance
To find out more about these and other books published by M K, as well as their wide range of clinical training courses, visit:
www.mkupdate.co.uk
Haemodynamic Monitoring and Manipulation
An easy learning guide
Fiona Foxall MA, RGN, ENBIOO, DPSN, BSC, PGCE
Head of Division, Continuing Development, School of Health, University of Wolverhampton, West Midlands, UK
With original artwork by Helen Blackburn
Haemodynamic Monitoring and Manipulation: An Easy Learning Guide Fiona Foxall
ISBN: 978-1-905539-46-8
First published 2009
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M K Publishing, phone: 01768 773030, fax: 01768 781099 or email: publishing@mkupdate.co.uk
Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages.
British Library Catalogue in Publication Data A catalogue record for this book is available from the British Library
Notice:
Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the Publisher. Neither the Publisher nor the author assume any liability for any injury and/or damage to persons or property arising from this publication.
The Publisher To contact M K Publishing write to:
M K Update Ltd The Old Bakery St. John s Street
Keswick Cumbria CA12 5AS
Tel: 01768 773030 Fax: 01768 781099
publishing@mkupdate.co.uk
www.mkupdate.co.uk
Designed and typeset in Adobe Garamond 10/12 by S. Maria Hampshire. Cover design by Luke Kelsey.
Printed in England by Reeds Printers, Penrith, Cumbria.
DEDICATION
For Peter:
Sleep peacefully my darling.
Contents
Acknowledgements
Introduction
How to use this workbook
Aims of this workbook
Chapter 1: Physiological maintenance of blood pressure
Chapter 2: Monitoring blood pressure using an arterial line
Chapter 3: Central venous pressure monitoring
Chapter 4: Monitoring and maintenance of cardiac output and tissue perfusion
Chapter 5: The effects of shock
Chapter 6: Use and effects of inotropic and vasoactive agents
Chapter 7: Putting it all together
References
Answers and Teaching Notes
Index
Acknowledgements
Thanks, as always, to Chris, Helen and Matthew Blackburn for all their help and support.
Introduction
The adequacy of the cardiorespiratory system can generally be gauged from basic clinical signs such as heart rate, blood pressure, respiratory rate and depth, skin texture and colour, use of accessory muscles of respiration and mental status. These basic signs should never be ignored, but in critical illness, basic clinical assessment alone may be unreliable and misleading. Therefore further monitoring techniques are usually required.
Appropriate haemodynamic monitoring is essential when caring for the critically ill patient, because it provides very valuable information about the circulatory status of the patient. It aids in early detection of shock and precise diagnosis, guides therapy, and monitors the effects of therapy. Cardiac output and the circulation can be manipulated by fluid and drug administration to ensure good oxygen delivery to the tissues but, in order to do this, ongoing monitoring is required (Jevon and Ewens, 2002).
Many healthcare professionals find it difficult to get to grips with the more complex forms of haemodynamic monitoring and the use of inotropic and vasoactive agents; indeed these things can seem rather daunting. If you work your way through this book and carry out the exercises, you will soon become more confident and competent about haemodynamic monitoring and manipulation as well as understanding all the information that initially seems so complicated.
Here s to easy learning!
How to use this workbook
It might sound obvious, but you should start at the beginning. Even if you feel quite happy about haemodynamic monitoring, it will be good revision. Steadily work through the material, ensuring you understand the information in each chapter before moving on to the next. Once you have read each chapter, complete the Consolidation section; these will make sure you understand the information sufficiently. Chapter 7 is a bit different from the other chapters; answer the questions and fill in the gaps as you work through the case studies. It will be helpful if you can find a mentor to discuss anything you are unsure about.
If you don t know a particular answer, try to work it out with the information you have already read. If you still can t, discuss it with your mentor. If it is still unclear, then look up the answer in the Answer section at the back of the book. If you do look up the answer, make sure you understand it - don t just accept it. You can talk to your mentor if you have any problems. The Answer section should only be used as a last resort and for checking purposes. It goes without saying that you will learn far more by working things out for yourself than merely reading the explanations provided.
If you already have a reasonable knowledge and understanding of haemodynamic monitoring and manipulation, you could - if you prefer - attempt the Consolidation sections before reading the explanatory text. This will give you a good idea of your current level of knowledge and will also identify any gaps, which you can then concentrate on filling.
Aims of this workbook
This book aims to extend your knowledge and clinical application of haemodynamic monitoring and manipulation.
After completing this workbook you will be able to:

Discuss the normal physiological mechanisms for maintaining blood pressure.
State the normal pressures within the cardiovascular system.
Define and state the significance of each parameter measured during haemodynamic monitoring.
Discuss monitoring of blood pressure using an arterial line.
Discuss monitoring and maintenance of central venous pressure.
Discuss monitoring and maintenance of cardiac output and tissue perfusion.
Discuss the effects of shock on the cardiovascular system and the pressures within it.
Discuss how cardiovascular pressures are manipulated by titration of inotropic and vasoactive agents.
Recognise abnormalities and describe what actions are appropriate.
Chapter 1
Physiological maintenance of blood pressure
The cardiovascular system exists to provide tissue perfusion. Tissue perfusion ensures the body s cells are provided with oxygen and nutrients at the same time as removing metabolic wastes (Gonce-Morton et al., 2005).
What is blood pressure?
All critically ill patients will need to have continuous blood pressure monitoring and you need to understand the significance of abnormal blood pressure. To understand it, you must first understand how normal blood pressure is maintained.

Simply, blood pressure is the pressure exerted against the arterial walls during the cardiac cycle.
(Gonce-Morton et al., 2005)
Mean arterial pressure is comparable to the perfusion pressure of the aorta, its major branches and major organs throughout the complete cardiac cycle. It is therefore representative of the average arterial pressure present in the peripheral circulation (Viney, 1999).
Controlling blood pressure
There are six physiological mechanisms for controlling blood pressure, namely: maintenance of blood volume, endocrine control, equilibration of cardiac input and output, peripheral resistance, the renin-angiotensin system and the baroreceptor reflex.
1. Maintenance of blood volume
If the fluid volume in the cardiovascular system is reduced, thirst then develops. This makes us take in more fluid. At the same time, urine output reduces as a result of ADH (antidiuretic hormone) production (ADH conserves fluid within the body by stimulating water reabsorption in the nephron). This is summarised in Figs 1.1 and 1.2.

Fig. 1.1 Maintenance of blood volume.

Fig. 1.2 Production and effects of antidiuretic hormone (ADH).
Conversely, the fluid volume in the cardiovascular system is increased, thirst is absent and urine output increases to rid the body of excess fluid.
2. Endocrine control
If blood pressure decreases, the adrenal medullae are stimulated