PARUL INSTITUTE OF NURSING
SUBJECT: ADVANCE NURSING PRACTICE
ASSIGNMENT
ON
“HEMODYNAMIC
MONITORING”
SUBMITTED TO: - SUBMITTED BY: -
Ms. Megha
Ms. Roma Patel,
Ghosh
Associate Professor,
1st Year M.Sc.
Parul Institute of
Nursing,
Nursing,
24PG250001
Parul University.
(2024 - 2026)
DATE OF SUBMISSION- 05-06-25
Hemodynamic monitoring
Hemodynamic monitoring is the mainstay in the care of critically ill patients and remains a
valuable adjunct to physical examination and diagnostics in the assessment, diagnosis, and
management of shock. It involves using invasive and noninvasive methods to provide
information about pump effectiveness, vascular capacity, blood volume, and tissue perfusion.
The precise data obtained from hemodynamic monitoring helps to identify the types and
severity of shock (cardiogenic hypovolemic, distributive, or obstructive). When paired with
clinical evaluation, hemodynamic monitoring is helpful in guiding the administration of
fluids, in selecting and titrating vasoactive drugs, and in deciding when mechanical support
might be necessary to treat refractory shock and allows for evaluation of the effectiveness of
treatment in real time.
The cardiac cycle & key definitions
Diastole
Diastole begins when the musculature of the atria and ventricles relax. During this
period, all four cardiac valves are closed.
During diastole, blood returns to the atria from the venous system. The inferior vena
cava and superior vena cava fill the right atrium with blood returning from the body
and the four pulmonary veins fill the left atrium with blood returning from the lungs.
The increasing pressure inside the filling atria push the atrioventricular (AV) valves
open, allowing the passive ventricular filling. At this point in the cardiac cycle, the
semilunar valve remains closed.
At the end of the diastole, the atria contract to forcibly fill the ventricles with extra
volume of blood. Contraction at the atria is referred to as atrial systole.
Systole
Shortly after atrial systole, ventricular systole begins. During ventricular systole, the
ventricles contract, pushing the AV valves closed and forcing the semilunar valves
open.
Blood is ejected from the ventricles through the semilunar valves. The right ventricle
moves blood into the pulmonary artery and left ventricle pushes blood to the body.
Definition Clinical consideration
Stroke volume (SV) The volume of blood Normal range is 60-90 mL
pumped out of the left
ventricles with each
contraction
End diastole volume (EDV) Volume of blood in the right Normal is about 120mL
ventricles (RV) or LV at the
end of diastole (filling)
End systolic volume (ESV) Volume of blood in the RV Normal is about 50 mL
or LV at the end of systole
(contraction)
Preload The amount of ventricular Also known as the left
stretch at the end of diastole ventricular end- diastolic
pressure (LVEDP)
Afterload The amount of resistance the Also known as the systemic
heart must overcome to open vascular resistance (SVR)
the aortic valve and push the
blood volume out into the
systemic circulation
Contractility The ability of the heart to
contract and generate force
and blood flow.
Clinical Assessment
Non- invasive monitoring
Electrocardiogram (ECG) :-
Heart rate is an important determinant of cardiac output (CO) (CO= HR * SV)
A 12- lead ECG confirm cardiac rhythm and provides baseline information on ST
segment and T waves.
Continues monitoring of the heart rate, cardiac rhythm, and segments allow for early
recognition of hypovolemia and myocardial ischemic.
Tachyarrhythmias are a common finding in certain shock states, bradycardia and/or
heart block may indicates cardiogenic shock.
Non – invasive blood pressure
Hypotension is a common feature of most shock states.
Blood pressure typically shows the pressures in the systemic vasculature during left
ventricular systole and diastole.
Mean atrial blood pressure is an average of the systolic and two line in diastolic
pressure. MAP can be used as an approximation of organ perfusion pressure.
Severely elevated BP, especially if acute, is associated with inadequate tissue
perfusion.
Pulse oximetry ( SPO2 )
Continuous SPO2 monitoring enables detection of a reduction in arterial oxygen
saturation, which is an integral part of oxygen delivery.
It allows for measurement of left ventricular ejection fraction (LVEF) and estimation
of SV and CO based on measurement of LV outflow tract (LVOT), LVOTY velocity,
and heart rate.
Echocardiogram
An echocardiogram provides visualization of the cardiac chambers, valves,
pericardium, and overall cardiac function.
It allows for measurement of left ventricular ejection fraction (LVEF) and estimation
of SV and CO based on measurement of LV outflow tract (LVOT). LVOT velocity,
and heart rate.
Fluid responsiveness
Fluid resuscitation is a key treatment strategy for hemodynamically unstable patient.
Although rapid optimization of volume status has been shown to improve outcomes,
volume overload is associated with increased morbidity and mortality
A fluid challenge is necessary to determine whether fluid administration will benefit
the patients
Fluid responsiveness is frequently defined as a increase in cardiac output (greater than
or equal to 10% from baseline) with a fluid challenge (250 to 500 mL administered
over 10 to 15 min).
Invasive monitoring
Intra – arterial blood pressure (ABP)
Arterial cannulation allows for accurate continuous blood pressure measurement.
Arterial line BP monitoring is the standard of care for patients on
vasopressor/inotrope infusions.
Arterial lines facilitate frequent blood draws for blood gases or other lab studies.
Central venous pressure (CVP)
The CVP is the blood pressure in the vena cava/ right atrium, normal range is 2-6
mmHg and normal diastolic PAP is 5-15 mmHg.
The CVP reflects venous return to right side of heart, or right ventricular preload,
which is a key component of RV function.
CVP is measure via a catheter positioned in the vena cava.
Pulmonary artery pressure (PAP)
PAP is the blood pressure in pulmonary artery. Normal systolic PAP range is 15 – 30
mmHg and normal diastolic PAP is 5-15 mmHg.
PAP may be measured during right heart catheterization or via introduction of a
catheter into the pulmonary artery.
Mixed venous oxygen saturation (SvO2)
SvO2 reflect the balance between oxygen delivery and oxygen consumption (V02).
It depends on the arterial blood saturation (SaO2), the balance between VO2 and CO2,
and hemoglobin (Hgb) levels.
Normal SvO2 is greater than or equal to 70%
Central venous oxygenation (ScvO2) is normally greater than or equal
to 65%
Hemodynamic values
Definition Calculation and normal
range
Cardiac output (CO) The volume of blood Normal range is 4-8 L/min
pumped through the heart
per minute
Cardiac index (CI) CO adjusted for body Normal range is 2.8 – 4.2
surface area (BSA) L/min/m2
Central venous pressure The blood pressure in the Normal range is 2-6 mmHg.
(CVP) vena cava and right atrial
diastolic pressure; used to
assess preload and volume
status.
Mean arterial pressure Systolic blood pressure + (2 Normal range is 70- 105
(MAP) * diastolic blood pressure) /3 mmHg
Right atrial pressure Reflects venous return to the Normal range is 70-105
right atrium and right mmHg
ventricular end diastolic
pressure
Right ventricular pressure Measured during catheter Normal RV systolic pressure
insertion is 15-25 mm Hg
Pulmonary artery pressure Used to diagnose pulmonary Normal PA systolic pressure
artery hypertension is 15-25 mmHg. Normal
mean PA pressure is 10-20
mmHg.
Pulmonary capillary wedge Reflects left atrial pressure Normal range is 6 – 15
pressure (PCWP) and left ventricular end – mmHg
diastolic pressure
Systemic vascular resistance The amount of resistance the Normal range is 800- 1200
(SVR) heart must overcome to open dynes – sec/cm2
the aortic valve and push the
blood volume out into the
systemic circulation
Pulmonary vascular Reflects the resistance the Normal range is less than
resistance (PVR) blood must overcome to 250 dynes – sec/cm-5
pass into the pulmonary
vasculature
