Clear Sight Noninvasive Monitoring FloTrac Minimally Invasive Monitoring Susan Volk MSN RN CCRN CPAN March 2016 Patient Population ClearSight andor FloTrac monitoring can be used on any patient population ID: 597734
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Slide1
Hemodynamic Monitoring
Clear Sight – Noninvasive MonitoringFloTrac – Minimally Invasive MonitoringSusan Volk, MSN, RN, CCRN, CPANMarch 2016Slide2
Patient Population
ClearSight and/or FloTrac monitoring can be used on any patient populationCare pathway patients, recurring ventral hernia patients will be monitored preop in P&H, intraoperatively, postop in PACU and for the first 48 hours in TCUSlide3
Hemodynamic Monitoring
Allows for the assessment of the heart and lungs ability to carry oxygen to the tissuesGoals:To ensure the adequate delivery and perfusion of oxygen to the tissueTo assess the effects of therapeutic intervention on the delivery and perfusion of oxygen to the tissuesSlide4
Cardiac Output
XSlide5
Stroke Volume
Stroke VolumeThe amount of volume ejected from the left ventricle per beat (stroke)Affected by Preload, Afterload, and ContractilitySV – 60-100 ml/beatSVI – 35-45Slide6
Cardiac Output
Cardiac OutputThe amount of blood that is pumped by the heart per unit time, measured in liters per minute (L/min)CO – 4.0-8.0 L/minCardiac IndexCardiac output divided by body surface areaCI – 2.5-4.0 L/min/m2Slide7
ClearSight
Finger cuff attaches to monitor
SV, CO, CI, & SVR values
obtained
Arterial line waveform
is obtained from
ClearSight
(arterial line is not in place)Slide8
FloTrac
FloTrac is a pressure tubing attached to an arterial line and connnected to the Edwards monitorSV, CO, CI, SVR values are obtainedFloTrac may be used on
high risk patients or those with poor perfusionSlide9
Preop
Abd Wall Reconstruction PatientsApply ClearSight fingercuff to patient
Measure width of patient finger
Finger cuffs are good for 72
hours
Place a
pt
label with height
& weight on the cord of cuffSlide10
Preop
Enter patient dataFIN, height, weight, gender
Click on the Home iconafter entering the dataSlide11
Patient Setup
Zero monitor & waveform
The zero & waveform screen appearsAlign the HRS & Fingercuff clip & zeroPlace the HRS at the
phlebostatic
axis
Attach the clip to the end of the
fingercuff
Zero patient & monitor, click on 0
Edwards monitor, message will
appear to zero Phillips monitor,
aftering
zeroing, click on waveformSlide12
Patient Setup
To start monitoring, click on green hand icon, so the green (-) turns red
Check the stability indicator
at the bottom of the screen
It will initially be (o) and will
t
hen will turn green when the
number reaches 30, the highest
the indicator goes is 70Slide13
Patient Setup
Enter CVP of 7 in order to get SVR
Click on Medical Bag icon,then click on enter CVPSlide14
Periop
Goal Directed Fluid Therapy
Measure initial SV & CI oncestability indicator reaches 30P&H will administer 250 ml NSS fluid bolus over 10 min
Check SV, if SV increases
by 10%, administer another
250 ml NSS over 10 min
Check SV, if 10% increase after
second bolus, contact
anesthesiologist for guidanceSlide15
Documentation
PreopDocument the initial Stroke Volume & Cardiac Index in a Progress Note, labeled “Hemodynamic Monitoring”Create an addendum in the progress note to document the SV & CI after the bolusesDocument SV & CI on Edwards Protocol form (place on chart, not permanent part of record)PACU
Document the SV & CI every 20 minutes in Powerchart on the Hemodynamic Monitoring FormSlide16
Hemodynamic Monitoring Form
Access from
AdHoc
Charting
Assessment folder
Display in
Vital Signs
tabSlide17
Saving Patient Data
Prior to the pt leaving PACU, click on the purple icon, select Data Download, select interva of 5 min, then Start DownloadA message will appear that data download is complete, remove USB port and leave in PACU officeSlide18
Tips for Successful Measurements
Keeping the patient’s hand warm will aid in perfusion & a better stability indicatorThe HRS needs to be at the phlebostatic axis
(if it is too low, the BP will appear falsely high)The clip that is attached is the finger cuff needs to stay in place (if it is too low SV will appear falsely low)If the patient is saying the cuff is too tight, click on the green hand icon to turn monitoring off and then release the cuffIf cuff is released without turning monitoring off, cuff may inflate and start leaking