MONITORING SYSTEMS

Presented by:- Dr. Keyuri Sanghani (PT)

MPT in Cardio-Pulmonary conditions
MONITORING SYSTEMS
• In ICUs, the need for minute by minute evaluation of the
cardiovascular system is paramount in the assessment of patient
stability. The monitors available are sophisticated and
computerized , and allow easy analysis.
• Nurses, doctors, physiotherapists and other medical staff must be
familiar with the monitors used in their units and trained according
to the Intensive Care Standards.
 The patient in intensive care will have several pieces of equipment
attached to a monitor, so that a visual display of measurements is
available, e.g. transducers, ECG leads, use oximetry probe and
thermometer.
 Perhaps the most important parameters are the alarm settings. If the
alarms sound, then the clinician's attention is drawn to the screen to
see the discrepancy.
 The clinician still needs to value the importance of assessing the
patient as an individual, and to look to the clinical signs of
instability-the monitors should not therefore exclude clinicians'
evaluation of the patient.
 THE MONITOR
 The monitor screen above the patient may display:
 Blood pressure (BP).
 CVP-Heart rate.
 Pulmonary artery pressure (PAP).
 Oxygen saturation (SpO2,).
 Patient temperature.
 Intracerebral pressure (ICP, CPP) (if available).
 ECG MONITORING
 Continuous ECG monitoring should be routine for any critically ill patient,
allowing the early detection of rhythm and rate abnormalities. Alarms are set
for individual requirements to alert staff at the earliest opportunity when
problems occur. Some monitors have a facility enabling the alarms to be set
automatically depending on the individual patient's readings.
 It is important for all staff working within the ICU to be able to recognize
sinus rhythm, sinus tachycardia and sinus bradycardia in addition to the life-
threatening rhythms of ventricular fibrillation, asystole, electromechanical
dissociation and pulseless ventricular tachycardia.
 The ECG electrodes are commonly positioned on the chest, and are very
subject to interference, so that it should not come the surprise if the ECG
trace goes peculiar or the alarms sound during chest physiotherapy.
 Normal ECG

SINUS
TACHYCARDIA
 OXYGEN SATURATION
 Pulse oximetry (SpO2) is an essential non-invasive method of
monitoring arterial oxygen saturation. It provides an early and
immediate warning of hypoxemia and should be used for any patient at
risk of hypoventilation or respiratory arrest.
 SpO2 readings below 95% occur when the oxygen delivery system is
inadequate to meet the needs of the tissues or cardiac output is poor,
resulting in tissue hypoxia. It should be used in conjunction with other
observations and monitoring and not used in isolation, as other factors
including artefact, vasoconstriction and abnormal hemoglobin, may
provide a false reading.
 ARTERIAL PRESSURE MONITORING
 Arterial pressure. Systemic blood pressure, popularly known as the BP can
be measured conventionally by nurse with a stethoscope or may be taken
automatically by machine. a cannula placed in an artery a radial artery at the
wrist is commonly used transducer).
 Arterial cannulation is commonly used in patients in the ICU to provide
access for arterial blood sampling and blood gas analysis; it is also used for
arterial pressure monitoring in patients with unstable blood pressure, and for
those patients on vasoactive drug therapy.
 All staff involved in caring for the patient need to be aware of the hazards of
invasive monitoring, which include the risk of cannula contamination,
disconnection and therefore haemorrhage, thrombosis, peripheral
embolization and ischemia of the digits. The arterial cannula cannot be used
as an intravascular route for drugs.
 CENTRAL VENOUS PRESSURE
(CVP)MONITORING
 The central venous cannula is inserted most frequently into the internal
or external jugular vein or subclavian vein. The tip is situated
approximately 2 cm above the right atrium in the superior vena cava.
Central venous cannulation provides access for intravenous therapy,
particularly for drugs. When connected to a transducer, the CVP can be
monitored providing an indication of the fluid status of the patient, the
function of the right side of the heart and an evaluation of the response
to vasoactive drugs.
 There are several causes of a rise in CVP including fluid overload,
myocarditis, pulmonary hypertension and ventricular septal defect with left-
to-right shunting.
 Hypovolemia and vasodilation can cause a decrease in CVP. Complications
include the risk of air embolism, pneumothorax, tamponade and
hemorrhage.
 Multilumen CVP lines are now in common use ,allowing separation of the
many drugs and solutions administered so that accidental over- or
underdosage is less likely to occur
 Normal CVP in the ventilated patient is between 6 and 12 cmH20.
 PULMONARY ARTERY PRESSURE
(PAP)
 Increasingly, the pulmonary artery catheter is used as a matter of routine in
the management of critically ill patients .It provides a measure of the
function of the left and right side of the heart, tissue oxygen consumption
and cardiac output. This information provides the necessary data to institute
the required drug therapy for the patient.
 The PAP is recorded when the balloon-tipped catheter is inflated and the tip
moves along with the blood flow to occlude a small pulmonary artery. The
inflated balloon blocks the recording of pressure behind it in the pulmonary
artery, allowing only the recording of pressures in the pulmonary capillaries
in front of it.
 A special flow-directed catheter, the Swan-Ganz catheter, with a balloon
attached to the tip has been developed to facilitate the passage into the
pulmonary circulation.
 Knowledge of the pressures within the heart is useful to assess the need
for surgery in patients with valvular disease.
 The pulmonary artery wedge pressure (PAWP) can predict the likelihood
of pulmonary oedema or guide complex fluid replacement in intensive
care units or operating theatres.
 Decrease in PAWP can be caused by fluid loss.
 Increase can be caused due to myocardial ischemia.
 Normal is 12-15 cmH2O.
 INTRACRANIAL PRESSURE (ICP)
 The ICP can be measured by means of a transducer connected to either
the extradural space or to the ventricles and can provide early warnings
of impending disaster, or testify to the adequacy of treatment. The
electro-encephalogram is a complementary investigation.
 Raised ICP occurs after head injury; other causes are cerebral tumor and
hypoxic brain damage. As ICP rises towards systemic blood pressure
then clearly blood flow to the brain must be reduced (and along with it
the supply of nutrients such as oxygen and glucose); the bony skull
cannot expand, and with the onset of cerebral oedema ICP rises sharply.
 TEMPERATURE
 It is important to know the patient's temperature as part of the general
assessment. For instance, fever is found in cases of sepsis and subnormal
temperature may be a sign of brain damage. Skin temperature as well as
central or core temperature is measured.
 High temperatures are associated with high oxygen consumption make it
all the more important for the lung to working well. In such cases the
patient may be treated deliberately by cooling,or fanning or by
placement on a blanket which circulates cold water to accomplish
cooling in a controlled manner.
 BLOOD GAS ANALYSIS
 Arterial blood gas sampling is required for the assessment of
oxygenation and ventilation while also providing information on the
acid-base state, adequacy of the circulation, and metabolic abnormalities.
ICUs frequently have their own blood gas analysis machine thereby
providing results and changes in treatment promptly ,samples of arterial
blood are typically taken from the radial artery.
NORMAL PARAMETERS IN
ABG ANALYSIS
Parameters Normal values
Partial pressure of oxygen Range 97 mm Hg (>80)
(PO2, PaO2)
Partial pressure of carbon 40 mm Hg (35-45)
dioxide (PCO2, PaCO2)
Hydrogen ion concentration 7.40 (7.35-7.45)
(pH)
Arterial oxygen saturation >95%
(SaO2)
Bicarbonate level (HCO3 ) 24 mmol/L (22–26)

Value Base excess/deficit 0 (2 to þ2)

(BE)
 OTHER MEASUREMENTS
 Fluid balance
 WEIGHT
 RESPIRATION
 GAS ANALYSERS
 LABORATORY INVESTIGATION
 Radiology
 The latest monitors contain powerful microprocessors which can store data
for future recall and examination, and perform a certain amount of data
handling and manipulation.
 It is becoming possible to relieve the nurses of a lot of the charting and
paperwork they have to do at present, thus allowing them to concentrate
more on direct patient care.
 Many ICUs will have a central station where staff can observe all beds while
performing administrative tasks.
 REFERENCES:-

 Physiotherapy for respiratory and cardiac problems 2nd edition- jenifer A.

pryor.
 Cardio vascular and pulmonary physiotherapy 2nd edition Johanne
watchie.
 Cash’s textbook of cardiovascular / respiratory physiotherapy.
Thank you!