Arterial Pressure Monitoring

Arterial Pressure Monitoring

Direct arterial pressure monitoring permits continuous measurement of systolic, diastolic, and mean arterial pressures and allows for arterial blood sampling. Because direct measurement reflects systemic vascular resistance as well as blood flow, it’s generally more accurate than indirect methods (such as palpation and auscultation of Korotkoff, or audible pulse, sounds), which are based on blood flow.

Direct monitoring is indicated when highly accurate or frequent blood pressure measurements are required, such as for patients with low cardiac output and high systemic vascular resistance. It may also be used for hospitalized patients who are obese or have severe edema—conditions that may make indirect measurement difficult to perform. It’s also useful for patients receiving titrated doses of vasoactive drugs and for those requiring frequent blood sampling.

Arterial pressure monitoring is used in critical care settings. To carry out monitoring, the doctor inserts an arterial catheter, which allows for direct arterial pressure monitoring. The procedure can be performed at the bedside under surgically sterile conditions.

Arterial monitoring equipment permits waveform evaluation and allows the nurse to make clinical decisions about changes in the patient’s therapy. (See Understanding the arterial waveform, page 30.)

A patient being monitored with an arterial pressure monitoring system can have blood samples for laboratory testing withdrawn from the arterial catheter. The arterial pressure monitoring system can be open or closed. An open system is one in which a Vacutainer is attached to the stopcock, withdrawing 5 to 10 mL of blood for waste, which is then discarded. A closed system has an attached reservoir that withdraws the waste; when all appropriate blood samples have been obtained, the blood in the reservoir can be returned to the patient.

According to the Centers for Disease Control and Prevention and the Infusion Nurses Society, the tubing and flush solution for an arterial line is considered a closed system and should be changed every 96 hours, immediately if contamination is suspected, or when the integrity of the product is compromised.1,2 In some cases, however, you may need to change the flush solution more frequently due to use.

Removal of an arterial catheter should occur as soon as possible to decrease the risk of complications, such as thrombosis and infection.1

Preparation of Equipment

Before setting up and priming the monitoring system, perform hand hygiene.3,4,5,6 Set up and prime the monitoring system. (See “Transducer system setup,” page 739.) Make sure you keep all parts of the pressure monitoring system sterile. Label all medications, medication containers, and other solutions on and off the sterile field.7 When you’ve completed equipment preparation, turn on the bedside monitor alarms according to your facility’s policy.

Jul 21, 2016 | Posted by in NURSING | Comments Off on Arterial Pressure Monitoring

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