Basic monitoring – non invasive
Basic monitoring provides information on the patient’s basic status.
For basic monitoring the patient is normally equipped with:
A Pulseoximetry - SpO2 finger sensor to monitor:
- Oxygen loading of the blood to identify respiratory disturbances
- Heart rate: first chance to identify bradycardia, tachycardia or arrhythmia
A non invasive blood pressure (NiBP) monitor to identify and monitor:
An ECG monitor to identify:
- myocardial ischemia
This symptomatic monitoring provides clues concerning any existing problems but not enough information regarding adequate treatment options.
The next step would be for the patient to be equipped with invasive catheters.A central venous catheter (CVC) is placed for:
Blood sampling for laboratory, blood cultures and venous blood gas analysis.
Monitoring ScVO2 as the major parameter in O2-balance monitoring is very important!
- Safe application
- Safe fluid administration
- Central Venous Pressure (CVP) Monitoring
An arterial line is placed for:
- Continuous blood pressure monitoring
- Sampling of blood for arterial blood gas analysis and other laboratory tests.
These additional tools provide options for more advanced diagnosis and can provide the trigger for escalation to advanced hemodynamic monitoring.
Advanced hemodynamic monitoring
Today many options for advanced hemodynamic monitoring are available. Below you will find a short overview of the most important systems with their strength and weaknesses.
It is very important to be informed of the limitations of each technology, in order to use it safely and efficiently.
- Echocardiograph (TTE, TEE)
- Echo visualizes cardiac performance
- Visualization of heart muscle action
- Visualization of valve function
- Measurement of multiple parameters of cardiac performance
- Quality of results dependent on the availability and qualifications of the physician doing the measurements.
PA-catheters can provide information on the right heart performance.
- Helpful in the treatment of isolated right heart failure
- Helpful in the treatment of pulmonary hypertension
- Training and frequent use is necessary for safe use
- Placement time of use for a PA-catheter is limited
- High risk for the patient (arrhythmia, inflammation, incorrect handling)
PiCCO is mainly used when you have to answer the question: “Volume or Catecholamine’s?)
- Only a CVC and an A-line are necessary
- Calibration by thermodilution can be performed by doctors and nurses
- Parameter portfolio provides a physiological overview
- Profile, Trend and SpiderVision screens help to identify the precise problem and optimize communication between doctors and nursesNo separation between right and left heart