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Icu monitoring ppt

Icu monitoring ppt

Intensive care unit ICU equipment includes patient monitoring, respiratory and cardiac support, pain managementemergency resuscitation devices, and other life support equipment designed to care for patients who are seriously injured, have a critical or life-threatening illness, or have undergone a major surgical procedure, thereby requiring hour care and monitoring.

An ICU may be designed and equipped to provide care to patients with a range of conditions, or it may be designed and equipped to provide specialized care to patients with specific conditions. For example, a neuromedical ICU cares for patients with acute conditions involving the nervous system or patients who have just had neurosurgical procedures and require equipment for monitoring and assessing the brain and spinal cord. A neonatal ICU is designed and equipped to care for infants who are ill, born prematurely, or have a condition requiring constant monitoring.

Intensive care unit equipment includes patient monitoring, life support and emergency resuscitation devices, and diagnostic devices. Intensive care equipment for life support and emergency resuscitation includes the following:. The use of diagnostic equipment is also required in the ICU. Mobile x-ray units are used for bedside radiography, particularly of the chest.

Mobile x-ray units use a battery-operated generator that powers an x-ray tube. Handheld, portable clinical laboratory devices, or point-of-care Nurse monitoring a central station for intensive care unit ICU equipment. Custom Medical Stock Photo. Reproduced by permission. A small amount of whole blood is required, and blood chemistry parameters can be provided much faster than if samples were sent to the central laboratory.

Disposable ICU equipment includes urinary Foley catheters, catheters used for arterial and central venous lines, Swan-Ganz catheters, chest and endotracheal tubes, gastrointestinal and nasogastric feeding tubes, and monitoring electrodes.

Some patients may be wearing a posey vest, also called a Houdini jacket for safety; the purpose is to keep the patient stationary. Spenco boots are padded support devices made of lamb's wool to position the feet and ankles of the patient. Support hose may also be placed on the patient's legs to support the leg muscles and aid circulation.

icu monitoring ppt

The ICU is a demanding environment due to the critical condition of patients and the variety of equipment necessary to support and monitor patients. Therefore, when operating ICU equipment, staff should pay attention to the types of devices and the variations between different models of the same type of device so they do not make an error in operation or adjustment.

icu monitoring ppt

Although many hospitals make an effort to standardize equipment—for example, using the same manufacturer's infusion pumps or patient monitoring systems, older devices and nonstandardized equipment may still be used, particularly when the ICU is busy. Clinical staff should be sure to check all devices and settings to ensure patient safety. Intensive care unit patient monitoring systems are equipped with alarms that sound when the patient's vital signs deteriorate—for instance, when breathing stops, blood pressure is too high or too low, or when heart rate is too fast or too slow.

Usually, all patient monitors connect to a central nurses' station for easy supervision. Staff at the ICU should ensure that all alarms are functioning properly and that the central station is staffed at all times. For reusable patient care equipment, clinical staff make certain to properly disinfect and sterilize devices that have contact with patients.

Disposable items, such as catheters and needles, should be disposed of in a properly labeled container. Since ICU equipment is used continuously on critically ill patients, it is essential that equipment be properly maintained, particularly devices that are used for life support and resuscitation. Staff in the ICU should perform daily checks on equipment and inform biomedical engineering staff when equipment needs maintenance, repair, or replacement.

For mechanically complex devices, service and preventive maintenance contracts are available from the manufacturer or third-party servicing companies, and should be kept current at all times.

Equipment in the ICU is used by a team specialized in their use.Hemodynamic monitoring is an integral part of ICU care. Need for invasive monitoring should be assessed carefully. Attention to technical details correct interpretation of data, and its application in selecting therapy should be individualized within the clinical context.

Following are its major recommendations. Advanced hemodynamic monitoring in selected cases: In Superspeciality facility in a Metro location.

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The ability of invasive blood pressure monitoring to identify beat to beat variability and long term trends is unsurpassed by any other currently available technology. In addition, presence of arterial catheter enables frequent sampling of arterial blood without arterial punctures in critically ill patients. At this pressure the catheter will be flushed with 3 ml saline per hour and help keep the catheter patent.

Heparinised saline is no longer routinely used. The reference point is usually at the level of the heart where the transducer is zeroed. Disclaimer: This site is primarily intended for healthcare professionals. Use of this site is subject to our terms of useprivacy policyadvertisement policy. Sign In Register. Sign in Register. These modalities include o Cardiac output- minimally invasive Pulse contour analysis e. Indications a Hemodynamic monitoring - beat to beat monitoring of blood pressure acutely hypertensive or hypotensive patients shock use of vasoactive drugs cardiac and cardiovascular surgery induced hypotension - pulse contour cardiac output monitoring b Frequent arterial blood gas sampling: critically ill patients including ventilated patient c Arterial administration of drugs, thrombolytics d Intra aortic balloon pump use e Noninvasive blood pressure monitoring not possible — e.

Other sites: axillary dorsalis pedis brachial, ulnar, posterior tibial and superficial temporal arteries Arterial Cannulation: The arterial line can be inserted using a simple catheter-over-needle arrangement with or without a guidewire or a set based on the Seldinger technique. Doppler or ultrasound can be helpful for difficult line insertion. Set up of the pressure tranducing system o The pressure transducing assembly consists of a coupling system, pressure transducer, amplifier and signal conditioner, analog to digital converter, microprocessor which convert the signal received from the vein or artery into a waveform on the a bedside monitor o The flushing system — is set up using a ml saline bottle encased in a bag pressurized to mm Hg.

Heparinised saline is no longer routinely used The reference point is usually at the level of the heart where the transducer is zeroed. ICU Technician One in each shift: 1. Nurse 3.Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection. Franges, Ellie Z. Ellie Franges is a nurse practitioner of neurosurgery at St. Bispectral index monitoring is used in the ICU to provide objective measures of the level of sedation in patients.

Bispectral index BIS monitoring has recently been used in the ICU to provide objective measures of the level of sedation in patients. Caring for critically ill patients presents multiple challenges for intensive care unit ICU nurses.

Because of the physiologic dynamics of critical illness, predicting the need for analgesia and sedation is difficult. It's our common goal when caring for patients to ensure adequate analgesia and sedation. Until recently, the only physiologic measures we had to ensure appropriate medication use were indirectly tied to patient comfort. This method often resulted in oversedation for patients, increasing ICU stays and overall morbidity.

Bispectral index BIS monitoring, an objective measure of the patient's response to sedation, has been used in anesthesia for over a decade.

This technology is finding its way into the ICU to provide a means of assessing the adequacy of sedation and preventing oversedation of critically ill patients. In the neurosurgical population, where the ability to perform a clinical exam is as important as providing comfort, BIS monitoring offers data that can prevent oversedation.

In addition, because BIS reflects electroencephalographic data, it adds to the objective information regarding brain responses. Bispectral index is also used to monitor sedation in patients with neurologic disorders, and clinical trials are using BIS monitoring to improve sedation protocols in endoscopy and interventional radiology.

Bispectral index monitoring measures cerebral electrical activity derived from an electroencephalogram EEG.

It reads the electrical activity from a frontal montage and processes several parameters including power spectrum, bispectrum, and time domain variables into a single numerical value that correlates to a level of sedation.

The digital BIS value ranges from 0 to A zero value correlates with an isoelectric EEG, while a value of indicates a fully conscious patient. The BIS monitoring system consists of a sensor and a display monitor.

The sensor is an electrode strip. Three of the electrodes, when properly placed, pick up EEG activity. A fourth electrode is used to measure artifact and electromyographic EMG resistance, which sends signals that contaminate EEG readings.

The monitor also provides information that can confirm the reliability of the data. The signal quality index SQI bar is used to evaluate the signal's reliability. A tracing without any isoelectric periods would have an SR of 0, whereas a fully isoelectric tracing would have an SR of Beginners to BIS monitoring can use the following technique: Placing the sensor : Place the electrode strip on either side of the patient's forehead.

Gently clean and dry the patient's forehead to remove oils.After you enable Flash, refresh this page and the presentation should play. Get the plugin now.

Toggle navigation. Help Preferences Sign up Log in. To view this presentation, you'll need to allow Flash. Click to allow Flash After you enable Flash, refresh this page and the presentation should play. View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Tags: eeg alva care continuous intensive monitoring unit. Latest Highest Rated. Is quantitative EEG really useful, or is it just window-dressing?

The decision to monitor is based in part on the main diagnostic question for the coma patient Who is seizing, a lot? Who is asleep? Who has brain ischemia? The general med-surg ICU pt? The neurological pt? Possible related issues Various clinical settings OR, ICU, office Types of sedatives Underlying structural disease Application by EEG-novices 39 Bispectral Index as a monitor for brain ischemia Cerebral perfusion monitoring for cardiac surgery Mixed results in efficacy Deogankar Hemerling Reported to be useful during cardioplumonary resuscitation Chakravarthy Cardiac arrest peri-op, BIS dropped to 0, returned to after 2 minutes of CPR, then increased to range for 24 hours Azim 40 A Case Example 34 yo man with history of thoracic spinal surgery 2 months ago presents with new onset generalized seizures, fever, and nuchal rigidity GTC seizure lasted 2 minutes, followed by unresponsiveness cEEG started 41 No Transcript 42 Considerations Why is this patient seizing?

Is the patient continuing to seize? How can I best prevent additional seizures? Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow. And, best of all, most of its cool features are free and easy to use. You can use PowerShow. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free.

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For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free.After you enable Flash, refresh this page and the presentation should play. Get the plugin now. Toggle navigation.

Help Preferences Sign up Log in. To view this presentation, you'll need to allow Flash. Click to allow Flash After you enable Flash, refresh this page and the presentation should play.

View by Category Toggle navigation. Products Sold on our sister site CrystalGraphics. Title: Hemodynamic Monitoring. Tags: hemodynamic hemodynamics monitoring. Latest Highest Rated. Look at trends!! SVR Vasoconstriction from shock Hypertension? Release or administration of epinephrine or other vasoactive inotropes Left ventricular failure 37 Best indicator of tissue perfusion.

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Monitoring in the Intensive Care

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Our new CrystalGraphics Chart and Diagram Slides for PowerPoint is a collection of over impressively designed data-driven chart and editable diagram s guaranteed to impress any audience.Indeed, the decisive endpoint is the supply of oxygen to tissues according to their metabolic needs in order to fuel mitochondrial respiration and, therefore, life. In this sense, both oxygenation and perfusion must be monitored in the implementation of any resuscitation strategy. Regarding respiratory monitoring of ventilated ICU patients, it includes serial assessment of gas exchange, of respiratory system mechanics, and of patients' readiness for liberation from invasive positive pressure ventilation.

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Also, the monitoring of nutritional and metabolic care should allow controlling nutrients delivery, adequation between energy needs and delivery, and blood glucose.

The goal of hemodynamic monitoring is to provide data that aids in the optimization of end organ tissue oxygenation and effectively combats global tissue hypoxia, shock, and multiorgan failure.

Traditional, noninvasive methods of hemodynamic monitoring pertained solely to physical examination, and invasive methods included central venous and pulmonary artery catheterization mostly. These pressure-derived preload values have been used extensively in the management of fluid resuscitation and titration. However, numerous studies of various patient populations sepsis, cardiovascular surgery, trauma, and other critical illnesses have challenged the notion that these indicators accurately predict volume status [ 1 — 7 ].

In fact a recent meta analysis showed no positive association between PAC use for fluid management and survival [ 8 ]. Recently, however, technologic advancements in this area have introduced new methods of noninvasive and less invasive hemodynamic monitoring.

Hemodynamic Monitoring - PowerPoint PPT Presentation

Generally, this data provides insight into the fluid status of the patient by indicating where the patient is on the Frank-Starling curve preload and may also provide insight into cardiac output, myocardial contractility, systemic vascular resistance, and more novel parameters related to the pulmonary vascular system. This chapter seeks to provide an overview of these new technologies and its implication in the critical care setting.

Identification of patients who are on the steep part of frank starling curve and therefore are fluid responsive is a core principle of hemodynamic monitoring and aids in the determination of the extent that circulatory homeostasis can be maintained with fluids alone, versus the need for inotropes or vasopressors. Similarly the continuous assessment of cardiac output, myocardial contractility, and vascular tone is crucial to the diagnosis and management of critically ill patients, and this has long been solely provided by the PAC catheter.

Recently, however there are new technologies that may provide this information in a less invasive or completely noninvasive manner. The concept of pulse contour analysis is a method of ascertaining the cardiac output from analyzing of the pulse pressure waveform. It is known that the pulse pressure is directly proportional to stroke volume and inversely related to vascular compliance. Also it is known that the pulse pressure waveform depicts the changes in stroke volume that occur with positive pressure ventilation.

Specifically, during the inspiratory phase of positive pressure ventilation, intrathoracic pressure increases passively, increasing right atrial pressure and causing venous return to decrease, decreasing right ventricular output, and after two or three heart beats affecting left ventricular output. Monitoring this stroke volume variation has shown to accurately predict patients who are fluid responsive [ 9 ].

These systems differ in their modality to assess for vascular tone their requirements for invasive monitoring and need for external calibration for CO measurements. A short discussion of each of these devices is in the following. The FloTrac has a proprietary software algorithm that analyzes characteristics of the arterial pressure waveform and uses this analysis, along with patient-specific demographic information, to determine continuous CO, systemic vascular resistance, and the dynamic parameter of stroke volume variation.

It carries the advantage of being able to be used for any arterial catheter in any arterial location. In addition, the device self-calibrates were based on patient demographics and waveform analysis.

Differences in patient populations, study environments intraoperative, postoperative, nonsurgicalFloTrac software versions, ventilatory settings, medical interventions, and reference standard s used intermittent thermodilution CO, continuous thermodilution CO, esophageal Doppler, PiCCOcombined with the relatively small single center studies, are all central to this issue.

This system also uses analysis of pulse contour from an arterial line to determine stroke volume and CO. However, the main difference is that this system uses a lithium-based dye-dilution technique to calibrate its pulse contour analysis algorithm, referred to as Pulse CO. After calibration, the LiDCO plus system can generate CO measurements using pulse contour analysis; however recalibration is recommended every 8 hours. It also requires an external calibration cold saline for this analysis.

The PiCCO monitor provides several other measurements as well including global end-diastolic volume measurements of all four heart chambers as well as extravascular lung water measurements. One of the limitations of this technology is the requirement for proximal artery catheterization with a thermistor-tipped catheter [ 10 ]. As with the other pulse contour technologies previously described, periods of significant hemodynamic instability result in potentially intolerable inaccuracies in CO measurement requiring frequent recalibration [ 11 ].Critically ill patients are often hemodynamically unstable or at risk of becoming unstable owing to hypovolemia, cardiac dysfunction, or alterations of vasomotor function, leading to organ dysfunction, deterioration into multi-organ failure, and eventually death.

With hemodynamic monitoring, we aim to guide our medical management so as to prevent or treat organ failure and improve the outcomes of our patients. Therapeutic measures may include fluid resuscitation, vasopressors, or inotropic agents. Both resuscitation and de-resuscitation phases can be guided using hemodynamic monitoring.

This monitoring itself includes several different techniques, each with its own advantages and disadvantages, and may range from invasive to less- and even non-invasive techniques, calibrated or non-calibrated. This article will discuss the indications and basics of monitoring, further elaborating on the different techniques of monitoring.

Hemodynamic instability, causing a mismatch between oxygen delivery and demand, is a major contributive factor for organ failure. Alterations in effective circulating volume e. We can often manage it with regular clinical examination and monitoring of certain basic vital parameters heart rate, blood pressure, central venous pressure [CVP], peripheral and central venous oxygen saturation, and respiratory variables and urine output, but when these fail there is an increased need for hemodynamic monitoring cardiac output [CO], pulmonary arterial occlusion pressure [PAOP or wedge pressure], pulmonary arterial pressure [PAP], mixed venous oxygen saturation [SvO 2 ], stroke volume variation [SVV], extravascular water, etc.

Over the last few decades, hemodynamic monitoring has evolved from basic monitoring of CO to sophisticated devices providing a plethora of variables.

These techniques and devices can be classified in either of two ways: 1 calibrated versus non-calibrated techniques and 2 by their degree of invasiveness invasive, less invasive, or non-invasive. In this article, we will provide an overview of the indications and limitations for hemodynamic monitoring and the available methods of doing so.

All patients admitted to the ICU should be monitored, but the degree of monitoring can vary. Hemodynamically stable patients require maybe nothing more than continuous electrocardiographic ECG monitoring, regular non-invasive blood pressure measurement, and peripheral pulse oximetry peripheral oxygen saturation or SpO 2. Those who are unstable, or at risk of instability, should receive an arterial line for continuous invasive blood pressure measurement and regular analysis of arterial blood gasses.

Any patient receiving vasopressors or inotropic agents requires a central venous line for drug administration and, when indicated, measurement of CVP and central venous oxygen saturation ScvO 2.

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Measuring CO and its components preload, afterload, and contractility will tell us if there is ongoing need for fluid resuscitation, vasopressors, or inotropic agents. It can be used as a diagnostic tool to determine the type of shock hypovolemic, cardiogenic, obstructive, or distributive according to the hemodynamic profile. Furthermore, it can be used to guide de-resuscitation, the phase after reconvalescence during which we are often confronted with fluid overload in itself an important negative prognostic predictor 23.

The clinical context emergency room, operating room, or ICU and the different possible variables provided by the monitoring method will determine which method we will use. There is, however, an important remark to be added when discussing indications for monitoring. Trials have as of yet not been able to show a significant reduction in mortality when comparing monitoring to standard of care, although there are possible benefits concerning complications 4 — 7.

In essence, this states that the blood flow to an organ can be calculated by using an indicator and measuring the amount of indicator that is taken up by the organ and its respective concentrations in arterial and venous blood.

When we think of the entire human body as the organ described and use oxygen as the indicator, we can measure CO using this formula:. In this formula, VO 2 is the consumption of oxygen and CaO 2 and CvO 2 are the arterial and mixed venous oxygen contents, respectively. The VO 2 can be measured using a spirometer within a closed rebreathing circuit. Arterial and mixed venous oxygen are measured using blood samples from a peripheral arterial line oxygenated blood and a pulmonary artery catheter PAC deoxygenated bloodrespectively.

This method is therefore invasive and time consuming, and although considered the gold standard it is rarely performed. Several invasive and less-invasive methods have been developed during the last few decades to measure CO.

It is still the gold standard in the clinical setting to which we refer when comparing different methods of hemodynamic monitoring.

icu monitoring ppt

These can be classified as calibrated or non-calibrated techniques or according to their level of invasiveness invasive, less invasive, or non-invasive. There is a trend to use more less-invasive and non-invasive techniques to reduce the risks that accompany less invasive techniques.

icu monitoring ppt