Arterial catheter, blood pressure monitoring with

Monitoring the patient in shock requires vigilance on the part of the nurse The patient s heart rate, blood pressure, and ECG are monitored continuously. The urinary output is measured often (usually hourly), and an accurate intake and output is taken. Monitoring of central venous pressure via a central venous catheter will provide an estimation of the patient s fluid status. Sometimes additional hemodynamic monitoring is necessary with a pulmonary artery catheter. The use of a pulmonary artery catheter allows the nurse to monitor a number of parameters, such as cardiac output and peripheral vascular resistance The nurse adjusts therapy according to the primary health care provider s instructions. 

Upon stabilization, placement of a pulmonary artery (PA) catheter may be indicated based on the need for more extensive cardiovascular monitoring than is available from non-invasive measurements such as vital signs, cardiac rhythm, and urine output.9,10 Key measured parameters that can be obtained from a PA catheter are the pulmonary artery occlusion pressure, which is a measure of preload, and CO. From these values and simultaneous measurement of HR and blood pressure (BP), one can calculate the left ventricular SV and SVR.10 Placement of a PA catheter should be reserved for patients at high risk of death due to the severity of shock or preexisting medical conditions such as heart failure.11 Use of PA catheters in broad populations of critically ill patients is somewhat controversial because clinical trials have not shown consistent benefits with their use.12-14 However, critically ill patients with a high severity of illness may have improved outcomes from PA catheter placement. It is not clear why this was... 

Continuous hemodynamic monitoring is essential during all phases of hypothermia. Cardiac monitoring is necessary because of the increased risk of arrhythmias. Cardiac output is decreased 5% for every 1°C of body temperature reduction. This is thought to be secondary to bradycardia, which has been shown to occur with hypothermia (3). A pulmonary artery catheter may be placed if there is any question of hemodynamic instability. Arterial catheters are used for continuous blood pressure measurement, as well as for access to arterial blood for blood gas and electrolyte analysis. 

More specific treatment to combat cardiotoxic effects is usually necessary in only a minority of instances in the series reported above (40), five patients (14%) had marked hypotension. Initial low left ventricular filling pressures were corrected within 3 hours by infusion of isotonic saline. Systemic hypotension persisted and was corrected by infusion of sympathomimetic amines. Routine insertion of a pulmonary artery catheter, with continuous monitoring of blood gases, pulmonary arterial pressure, left atrial wedge pressure, and cardiac output have been recommended (40). Volume expansion is suggested for low left atrial pressure,... 

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