 What comes to nursing school explained in this video on hemodynamic monitoring that specifically focuses on central venous pressure and pulmonary artery wedge pressure. Now keep in mind as a nursing student in the new grant you will not be expected to know all the details that it takes for these kind of monitoring devices. This is a training that will be specifically provided to nurses who work in the intensive care unit and there are many classes that they need to take to become familiar with the monitoring devices and also how to care for the patients that actually require this kind of monitoring. This video is more of a basic overview so that you can kind of understand how it relates to hemodynamics as well as cardiac output. I highly recommend that you watch my other video on cardiac output that explains how it relates to stroke volume and heart rate so that you have a basic understanding of what we really are talking about here when the end goal is really to monitor cardiac output by the means of these invasive lines. Hemodynamic monitoring is really needed to assess the patient's heart function by assessing that cardiac output. It also helps us to determine the patient's fluid volume status so that we can then have goal directed therapy and monitor the patient's medications that we might be administering as well as their overall fluid volume status and the effect that the medications have on the patient and the reason really is that anybody with heart failure or any of these reasons over here it is very difficult to find the right amount of fluid in these patients and maybe too much fluid in a patient with heart failure or any of these other problems can cause a lot of issues and could put the patient in pulmonary edema which is a complication from heart failure. So by having these hemodynamic monitoring devices and readings available to us it allows us to really very gently monitor the patient and have the goal directed therapy to make sure that they're getting the correct medications and we don't put them in fluid volume status by administering these medications very very carefully. Now if they are already in fluid volume overload then the again the monitoring devices help to monitor how bad the fluid volume overload is and then what the effects again of the medications have to reduce that fluid volume overload. So first of all central venous pressure also called CVP measures the right ventricular preload which can really also be called the stroke volume and therefore it measures the fluid volume status. It sits in the right atrium and in the CVP is increased that means that there's fluid volume excess too much fluid in the system and if the CVP is low it measures the patient is dehydrated or that there's fluid volume deficit which could also be a loss of blood. So central venous pressure is basically a measure of fluid volume status. Now it is available to monitor with a swan-ganz catheter as well as a triple lumen central line. Sometimes the pulmonary artery pressure monitoring or wedge pressure is also referred to as a swan-ganz catheter and really what that means the swan-ganz catheter is just a device that actually measures or is the invasive line where the pulmonary artery wedge pressure is the actual site that the end of that catheter resides in and helps us measure the cardiac output. So to go back here to the pulmonary artery pressure monitoring or wedge pressure it measures the left ventricular end diastolic pressure. So just think about for a moment what that means. So at the end of diastole at the end of realization it measures the pressure in that left ventricle. Remember that we cannot really put an invasive device in the left ventricle because we can only insert it usually from either the internal jugular or subclavian vein and central line that then go is threaded through the patient's right atrium, the right ventricle and then it might be threaded to into the pulmonary artery. But there is no way of us to continue into thread that from the pulmonary artery to the pulmonary vein to the left side of the heart. It just takes way too much length and will be way too dangerous to do that. So by measuring the pulmonary artery wedge pressure it gives us a pretty good understanding by using kind of formulas in the background as to what the patient's cardiac output is. So both of these invasive pressure or hemodynamic monitoring is used for patients with left ventricular failure, patients with valve disorders, pulmonary hypertension, any kind of shocks, complication from an MI that could include cardiogenic shock as well as myocarditis, patients that are candidates for transplant or patients with severe heart failure that require vasoactive drugs which would include positive inotropes, vasopressors or vasodilators. And keep in mind that inotropes are the ones that help us with the contractility which is also a factor that helps determine cardiac output. Vasopressors we would need when there's fluid volume deficits and then vasodilators we would need when there's fluid volume excess to help regulate the patient's blood pressure. Now for the pulmonary artery pressure monitoring we already talked about the small against catheter that's the actual line that's inserted. And it measures the patient's heart function so the cardiac output through that PA pressure and also helps determine the patient fluid status. When the pulmonary artery pressure is increased and the pulmonary artery wedge pressure are increased that's usually means that the patient is in heart failure it has fluid volume overload or fluid volume excess. When there are low readings in the pulmonary artery pressure and the pulmonary artery wedge pressure that usually means that the patient is in fluid volume deficits. Now here I have two drawings and I hope it'll help you relate how this catheter really works and where the different parts of it sit and what they help us monitor. So over here we have the central line that again is inserted in the internal jugular or the subclavian vein here and keep in mind it's inserted in the vein not in an artery an arterial line is something different so watch the video on that. And so there are basically five chords. The first one is the thermistor which we'll talk about here in a little bit and then we have three different hubs here dysto, lumenhub, proximal and fusion lumenhub and proximal injecting lumenhub. And these three are pretty much the same they look like a lower lock end of an IV tubing or just the saving lock that the patient would have so it's the same kind of a port that they have however because it's a central line some facilities require having an alcohol soaked kind of a cap on it to keep it from causing infection in the patient when we access them. So these three hubs as well as the thermistor and then the balloon inflation valve they all kind of come together in this one valve and so this will be outside the patient and somewhere here it'll be the insertion site in one of those veins that we just discussed and it's inserted into the patient and we have here again color coded the balloon is at the end here and that kind of looks like the balloon of a catheter of a holy catheter for example that can be deflated and inflated and corresponds to this balloon inflation valve here that is designated only for the inflation of that balloon it's used for nothing else and then over here we have the proximal fusion port the proximal injecting lumenhub or hub and then the dysto lumenhub. Keep in mind dysto always means the farthest away so these are the farthest away and then the proximals are a little bit closer and all that these hubs these three hubs can be used for fluid administration medication administration such as these vasoactive drugs or vasodilators which I'll discuss and it can also be used for blood sampling so just like arterial lines can be used for arterial blood gas sampling we can actually hook up a syringe here and draw blood from the central line and save the patient from having to get repeated sticks into their extremities for blood draw so that's a very nice feature of this central line of swung against catheter in this case now before we look into where these different parts end up in the actual heart if this was not a swung against catheter and we would simply have a triple lumen central line that would only measure central venous pressure then we wouldn't have the thermistor and we wouldn't have the balloon inflation valve we would have these three hubs here hence triple lumen central line so three lumens central line so it's just a different catheter that has three lumens versus the additional thermistor and balloon inflation valve that the swung against catheter has that allows us to monitor the pulmonary artery pressure in which pressure and then if we here look at the heart so here we have the right side of the heart with the atrium and ventricle and then the left side with the atrium and ventricle and then we have the pulmonary artery coming out from the left from the right ventricle into the lungs so then with this line as it inserts into the patient it comes in here and it sits in that right atrium and here at the proximal infusion port in green it allows us to measure our central venous pressure by sitting in that right atrium then the the line continues and the proximal injected lumen having purple here sits in the patient's right ventricle and then the catheter continues all the way into the pulmonary artery because this is what this catheter is and then the balloon like we talked about here is at the end and then the distal lumen port is at the very tip of that catheter and the balloon is usually deflated now when we do want to measure the cardiac output we basically inflate the balloon and because it sits in the vasculature there it's when you inflate it it kind of wedges itself into the pulmonary artery smaller blood vessels therefore it's called pulmonary artery wedge pressure so it gets wedged in there now this balloon inflation valve we talked about is a designated port for only that one purpose and it can only be inflated for very brief periods of time because we don't want to put a lot of pressure into these fragile pulmonary artery blood vessels and that's pretty much how this relates so you can see the color coding and the different places that these different hubs end up actually in the patient when we apply the line to the heart and then the cardiac output calculation depends on temperature for the solution that we are actually in fusing into the patient it is monitored by the pulmonary artery pressure and again we could not thread this catheter into the patient's lungs and then have to come back to the left ventricle that is way too complicated and way too many complications but the hemodynamic monitoring allows us by monitoring the pulmonary artery pressure to calculate the patients left ventricular and diastolic pressure and get a good idea about what the patient's cardiac output and actually also cardiac index are in addition we talked about these triple lumens here allow us to sample mixed venous blood because we can draw the blood out of there and that can help us evaluate the patient's actual or two saturation now let me look this over to make sure we've covered everything here i think so the one point that i want to emphasize is that the cvp can be measured again with the swungance this whole catheter with all five ports or it can just be done with the simple air quotes triple lumen central line where we would only have these three hubs that just allow us to infuse different medications into the same patient line now one more caveat here a central line a lot of times is indicated if the patient is critically ill because we need to infuse a lot of different medications a lot of different fluids and if we just have peripheral ivs first of all they are more prone to getting infiltrated or causing other problems and also the patient might need three or four different peripheral lines now the central line is nice because the medications go straight in to the patient's larger blood vessels well we don't really have to worry much about infiltration causing trouble because we're in that large blood vessel now it is one line as you can see over here all these lines end up in one line here with the different ports but because we have different ends where these ports end up we can infuse non-compatible medications in the same line we just have to hook them up to different ports so for example you could hook up whatever iv fluids the patient is on with an antibiotic as a piggyback to the distal lumen hub and then over here you could have a vasoactive drug that's usually not compatible with that antibiotic so you could hook these up here which is very nice and again you only have one line to care for rather than multiple peripheral lines that would be at risk for infiltration and all these other complications phlebitis and so forth that we don't want to occur so that's another little caveat here and in the triple lumen we talked about with the swungans so hopefully this has helped you get a little bit of a better understanding of this hemodynamic monitoring and what that really means and how it relates to the places that it ends up in the patient's heart please also watch the other video that i have on arterial lines for arterial block pressure monitoring in any other videos in the critical care list that you think would be beneficial thanks for watching