Hemodynamic monitoring

[mmcmarsh]

I've read a lot of posts from people who are experiencing a decrease use in invasive monitoring. I think in the year I've been in the CCU (non post-surgical), we've had one line. I was wondering if any of your facilities or units are using the non-invasive monitoring. Do you feel that it is accurate? Do your doctors like using it? For those who have used both systems, do you have a preference?

[MatthewRN]

I've never seen the non-invasive monitoring in my unit. What does it involve?

[jennt9]

Hello

I had the pleasure of working in a CCU for just over two years at a heart specific hospital in Canada. I agree that PA catheter lines have seem to become a thing of the past although we still saw them now and again (it always seemed to depend on which attending was on CCU service).

I found that with pulmonary hypertension patients or pre-cardiac transplant patients the staff were quite keen on inserting them yet very rarely changed the direction of care based on the hemo calcs (CO, CI, etc).

Hemodynamics can range in levels in invasiveness- arterial lines, PA lines, central lines (CVP). I think there is a trend of moving away from this is because of the high rates of infections and now hospitals (in canada anyways) are forced to make infection rates public for any and all to view. I also think that for patient comfort level and mobility there is a push to remove the lines as soon as patients are hemodynamically stable. I hope this helps, I am now working in a medical-surgical ICU and am missing my cardiac patients- i still get nervous with every bolus I give!:)

[jennt9]

Non- invasive hemodynamic monitoring would include the cardiac monitor and the blood pressure cuff:)

[iluvivt, BSN, RN]

If used at all they are only in 1-3 days. We use the open-ended triple or dual lumen power PICCS for CVP monitoring and still get these reading all the time. They get the PICC anyway so to be able to use it for monitoring is a bonus.

[mmcmarsh]

Yeah...I was thinking a little more advanced than the bp cuff...

I was thinking along the lines of a transcutaneous monitoring system I've read about...and also about something that is like a NG tube...but with the function of a TEE. So I guess the second wouldn't technically be non-invasive.

[nursejill155]

We have an external CO/CI machine that we use occasionally. I have used it once only and it involves putting patches on the pt carotids but Imy experience is that it is not very accurate. I have a pt that it was read the CI was 1.4-1.7 and once she had a swan her index and output were much higher then the external machine. That has been my experience but again I have only seen it once.

[RN1980]

i just don't see how that stuff gets accurate numbers without putting a sensor in a pulmunary artery and getting true pressures.

[ghillbert, MSN, NP]

Actually some of the non-swan CO monitors are pretty accurate, depending on the patient patho. They aren't exactly non-invasive, you still need an arterial line and CV line. The bioimpedance models seems less accurate in critically ill patients.