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Monitoring in ICU

Invasive haemodynamic monitors

Critically ill patients can have rapidly changing physiology and require more invasive monitoring which give real time, accurate and beat-to-beat measurements of haemodynamic parameters.

Most patients in ICU have an arterial line and a central line. In addition some patients have a method of measuring cardiac output e.g. pulmonary artery floatation catheter (PAFC)/ PICCO / LiDCO / ODM (Oesophageal Doppler Monitor).  See Table 1 below for the common indications for invasive haemodynamic monitoring.

Many other types of monitors exist – e.g. intracranial pressure monitors - these will be used on specialised units and you should familiarise yourself with them if you are working in one of these units

 

INDICATIONS FOR HAEMODYNAMIC MONITORING

Abnormal physiology that fails to normalise quickly with simple measures

Unstable haemodynamic condition or potential for rapid deterioration

Use of drugs (vasopressors and inotropes) that can alter cardiovascular physiology rapidly

Intra-arterial lines are used for frequent blood analysis

Central IV access to enable the delivery of multiple infusions e.g. drugs (including veno-irritant drugs), fluids and parenteral nutrition

Table 1. Indications for invasive haemodynamic monitoring

General guidance notes on insertion of invasive lines

Competency in the technique includes assessment of indication and risks, knowledge of contraindications and complications, knowledge of relevant anatomy, and explanation and consent of patient (if appropriate).

Aseptic technique should be used for all procedures. If there were no time to wash your hands then one would question whether a central line is appropriate!

After the insertion of an invasive monitoring line, the patient should be kept in an appropriate environment and should be looked after by staff trained in care of the device and line.

  

Removal of invasive lines

Invasive monitors have associated risks, they should only be inserted if necessary and should be removed as soon as they are no longer required. Most ICUs do not change lines routinely after a set amount of time, however lines should be removed if there is evidence of line-associated complications – such as infection at the site, extravasation of fluid or drugs, or ischaemia distal to an arterial line.

Bacteraemia can be associated with infected lines and if there is evidence of systemic infection then blood cultures should be taken from the line and from a peripheral vein and consideration should be given for removing or changing the invasive line.

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