6. monitoring hemodinamik1.ppt

7/25/2019 6. MONITORING HEMODINAMIK1.ppt

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MONITORINGMONITORING

HEMODINAMIKHEMODINAMIK

RSUP. DR. WAHIDINRSUP. DR. WAHIDINSUDIROHUSODOSUDIROHUSODO


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What is Hemodynamic Monitoring?What is Hemodynamic Monitoring?

Non-invasive = clinical assessment & NBPNon-invasive = clinical assessment & NBP

Direct measurement of arterial pressureDirect measurement of arterial pressure

Invasive hemodynamic monitoringInvasive hemodynamic monitoring


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Noninvasive Hemodynamic MonitoringNoninvasive Hemodynamic Monitoring

Noninvasive BPNoninvasive BP

Heart Rate pulsesHeart Rate pulses

!ental "tatus!ental "tatus

!ottling #a$sent%!ottling #a$sent%

"in 'emperature"in 'emperature

(apillary Refill(apillary Refill

)rine *utput)rine *utput


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Why A Properly Fitting Cuff?Why A Properly Fitting Cuff?

'oo'oo smallsmallcauses false-high readingcauses false-high reading

'oo'oo /7R89/7R89causes false-lo3 readingcauses false-lo3 reading


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OBJEKTIF : reviewOBJEKTIF : review

Arterial LineArterial Line

Tekanan vena sentralTekanan vena sentral

Kateter arteri !l"#nalKateter arteri !l"#nal$ In%ikasi$ In%ikasi

$ Nilai$nilai & interetasi 'el#"(an'$ Nilai$nilai & interetasi 'el#"(an'

$ Teknik en'!k!ran$ Teknik en'!k!ran$ Pr#(le" & e"e)a*ann+a$ Pr#(le" & e"e)a*ann+a

$ K#"likasi$ K#"likasi


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Sens#r *ar!s "en%eteksi si'nalSens#r *ar!s "en%eteksi si'nal

se)ara ak!ratse)ara ak!rat

,#nit#rin' ti%ak erna* se(a'ai,#nit#rin' ti%ak erna* se(a'aiterae!tikterae!tik

-val!asi resik#$ke!nt!n'an-val!asi resik#$ke!nt!n'an

"en''!nakan "#nit#r"en''!nakan "#nit#r

,#nit#rin' a%ala* s!at! ti" r#ses,#nit#rin' a%ala* s!at! ti" r#ses


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Intra arterial pressureIntra arterial pressure

Pen'!k!ran lan's!n' tekanan %ara*Pen'!k!ran lan's!n' tekanan %ara*

Teknik le(i* ak!ratTeknik le(i* ak!rat

In#r"asi *e"#%ina"ik k#ntin+!In#r"asi *e"#%ina"ik k#ntin+! Pen'a"(ilan "!ltiel sa"el %ara*Pen'a"(ilan "!ltiel sa"el %ara*

arteriarteri


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Interpretasi gelo!ang te"ananInterpretasi gelo!ang te"anan

#ara$ arteri#ara$ arteri

MAP

Diastol

ik

Diastol

ik

DicroticNotch

Sistolik

Sistoli

k

115mmHg

85mmHg


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%a#a "on#isi apa perlu%a#a "on#isi apa perlu

pengu"uran invasivepengu"uran invasive

arterial pressure &arterial pressure &Ak!t *i#tensi ata! er%ara*anAk!t *i#tensi ata! er%ara*an /ir)!lat#r+ #r )ar%ia) arrest/ir)!lat#r+ #r )ar%ia) arrest

Hiertensi krisisHiertensi krisis SesisSesis

Ne!r#l#'ik in0!riNe!r#l#'ik in0!ri

K#"likasi #st #erasiK#"likasi #st #erasi Pasien %en'an vas#a)tive %r!'sPasien %en'an vas#a)tive %r!'s

Pasien "e"(!t!*kan e"eriksaanPasien "e"(!t!*kan e"eriksaananalisa 'as %ara* +an' serin'analisa 'as %ara* +an' serin'


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Ter'ant!n' set!Ter'ant!n' set!

$ 1!nakan t!(in' +an' teat$ 1!nakan t!(in' +an' teat

$ 2e(as %ari !%ara$ 2e(as %ari !%ara$ K#neksi$k#neksi ken)an'$ K#neksi$k#neksi ken)an'

$ er# & kali(rasi$ er# & kali(rasi

$ P#sisi %ari tran%!)er$ P#sisi %ari tran%!)er Hearin ata! ti%ak Hearin ata! ti%ak


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PeralatanPeralatan

$ Press!re (a'$ Press!re (a'

$ Na/l 7 8 5 ))$ Na/l 7 8 5 ))$ Press!re tran%s%!)er an% in!si#n$ Press!re tran%s%!)er an% in!si#n

setset

$ Kann!la$ Kann!la$ 9 *earin :;$< !nits="l>$ 9 *earin :;$< !nits="l>


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%ersiapan Alat:%ersiapan Alat:


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;.;. Set siste" en'!k!r %an ress!re (a'Set siste" en'!k!r %an ress!re (a'3 ""H'3 ""H'


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Kali!rasiKali!rasi

Alikasi %ari tekanan +an'Alikasi %ari tekanan +an'

%iketa*!i kea%a siste" !nt!k%iketa*!i kea%a siste" !nt!k

"e"astikan keteatan"e"astikan keteatan


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Kopli"asiKopli"asi

Per%ara*anPer%ara*an

He"at#"aHe"at#"a

Arterial tr#"(#sisArterial tr#"(#sis -"#li !%ara-"#li !%ara

IneksiIneksi


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MA'A(AHMA'A(AH %EN)EBAB%EN)EBAB %EME*AHAN%EME*AHAN

$Dara* (alikDara* (alik

ke t!(in'ke t!(in'

$Ti%ak a%aTi%ak a%a'a"(ar'a"(ar

'el#"(an''el#"(an'

$Sa"(!n'anSa"(!n'an

leasleas$St#)#)kSt#)#)ktert!t! ke !s*tert!t! ke !s*s+ste"s+ste"

$Ti%ak a%ek!atTi%ak a%ek!atkant#n' tekanankant#n' tekanan

$S!"(er listrikS!"(er listrik"ati"ati

$Trans%!)erTrans%!)erti%ak ter(!ka keti%ak ter(!ka ke

kateterkateter

$/ek sa"(!n'an/ek sa"(!n'an

%an ken)an'kan%an ken)an'kan$2!ka St#)#)k2!ka St#)#)k

$Isi kant#n'Isi kant#n'tekanan 3tekanan 3

""H'""H'

$/ek aliran$/ek aliran

listriklistrik/ek siste"/ek siste"

H!(!n'kanH!(!n'kantrans%!)er ketrans%!)er ke

"#nit#r"#nit#r


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%EN)EBA%EN)EBABB

INTER+EN'IINTER+EN'I %EN*EGAHAN%EN*EGAHAN

$1a"(ar1a"(ar

tekanantekanan%a"e%%a"e%

$Seleksi skalaSeleksi skala

ti%ak (enarti%ak (enar$KateterKatetertertek!ktertek!k

$A%a !%araA%a !%araa%a siste"a%a siste"

$2ek!an %ara*2ek!an %ara*

$K#neksi leasK#neksi leas

$/#"liant/#"liantt!(in't!(in'

$Per!(a*anPer!(a*an

k#n%isi asienk#n%isi asien

$Set skala tekanaSet skala tekana

+an' teat+an' teat$Re#sisi kateterRe#sisi kateter

$Kel!arkan !%araKel!arkan !%ara

%ari siste"%ari siste"$Asirasi %ara*Asirasi %ara*%ati kateter !s*%ati kateter !s*

$Ken)an'kanKen)an'kan

k#neksik#neksi$1!nakan stiE1!nakan stiEt!(in't!(in'

$Ka0i %an treatKa0i %an treat


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%EN)EBA%EN)EBABB

INTER+EN'IINTER+EN'I %EN*EGAHAN%EN*EGAHAN

$Pe"(a)aaPe"(a)aa

n ti%akn ti%aka%ek!ata%ek!at

$Per!(a*anPer!(a*an

reeren)e levelreeren)e leveltran%!)ertran%!)er

$Tran%!)erTran%!)er

%iatas reeren)e%iatas reeren)e#int *asil#int *asile"(a)aane"(a)aanren%a*ren%a*

$Tran%!)erTran%!)er%i(aFa*%i(aFa*reeren)e #intreeren)e #intkesala*an *asilkesala*an *asil

e"(a)aane"(a)aan

$Perta*ankanPerta*ankan

tran%!)er a%atran%!)er a%ale(#stati) aisle(#stati) aisata! kateter tiata! kateter tilevel a%a saatlevel a%a saat"elak!kan"elak!kane"(a)aane"(a)aan

$/ek siste"/ek siste"asirasi !%araasirasi !%araata! (ek!an %ariata! (ek!an %arisiste"siste"


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Te"anan +ena 'entralTe"anan +ena 'entral

,e"#nit#r tekanan intra)ar%ia),e"#nit#r tekanan intra)ar%ia)

Ti%ak (er!n'sin+a Gentrik!lar +an'Ti%ak (er!n'sin+a Gentrik!lar +an'

(er*!(!n'an %en'an(er*!(!n'an %en'an

is)*e"ia Garv!lar ti%ak n#r"al ata!is)*e"ia Garv!lar ti%ak n#r"al ata!

Pri"ar+ "+#)a%ial %iseasePri"ar+ "+#)a%ial %isease

,e"(e%akan antara *+#v#le"ia,e"(e%akan antara *+#v#le"ia

%an "+#)ar%ial %eressi#n%an "+#)ar%ial %eressi#n


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Te"anan venaTe"anan vena

sentralsentral


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(eta" vena su!,lavia(eta" vena su!,lavia


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In#i"asiIn#i"asi

;.;. PenilaianPenilaian


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'etting *+% anoeter'etting *+% anoeter

Salin n#r"al ata! lar!tan Detr#se 5Salin n#r"al ata! lar!tan Detr#se 5

88

Si"le IG setSi"le IG set

,e"an)in' /GP "an#"eter t!(in',e"an)in' /GP "an#"eter t!(in'

9 ; )" %ari air ke%ala"9 ; )" %ari air ke%ala"

"an#"eter"an#"eter Pin%a*kan se"!a 'ele"(!n' a%aPin%a*kan se"!a 'ele"(!n' a%a

k#l#" airk#l#" air


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Jenis Kanula *+%Jenis Kanula *+%

Sin'le L!"enSin'le L!"en

$ L#n' an'l#)at* :;61 ;41>$ L#n' an'l#)at* :;61 ;41>

$ /ata :3C"" 4C5"">$ /ata :3C"" 4C5"">$ Per)!tane#!s s*eat* 7C? J.5?>$ Per)!tane#!s s*eat* 7C? J.5?>

$ SFan S*eat* :J.5?>$ SFan S*eat* :J.5?>

,!ltile l!"ens,!ltile l!"ens$


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(ang"a$-lang"a$ 'etting(ang"a$-lang"a$ 'etting

*+% onitorng line*+% onitorng line;.;. Pen'a%aan -/1 "#nit#rin'Pen'a%aan -/1 "#nit#rin'


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+ein atau Arter. &+ein atau Arter. &

Arter.Arter. +ein+ein

/#l#!r # (l##%/#l#!r # (l##% 2ri'*t re%2ri'*t re% DarkDark

re%re%

Press!rePress!re Hi'*Hi'* L#FL#F

Rai% (a)kRai% (a)k #F # (l#%#F # (l#%

2l##% 'as2l##% 'as Hi'* PaO


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Kopli"asi *+%Kopli"asi *+%

/#r#ti% arter+ !n)t!re/#r#ti% arter+ !n)t!re

Pen!"#t#raPen!"#t#ra

Air e"(#lis"Air e"(#lis"Arr+t"iaArr+t"ia

Per#rati#n # SG/ #rPer#rati#n # SG/ #r

atri!"=ventri)le)ar%ia) ta"#na%eatri!"=ventri)le)ar%ia) ta"#na%e IneksiIneksi


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3;

Central Venous Pressure CVP!Central Venous Pressure CVP!

(entral line or pulmonary artery catheter(entral line or pulmonary artery catheter

Normal values = , : 0 mm HgNormal values = , : 0 mm Hg

/o3 (;P = hypovolemia or/o3 (;P = hypovolemia or venous returnvenous return

High (;P = over hydration venous returnHigh (;P = over hydration venous return or right-sided heart failure or right-sided heart failure


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&ynamic Flush&ynamic Flush

Dynamic flush ensures the integrity

of the pressure tu$ing system5Notice ho3 it ascends - forms as>uare pattern - and $ounces $elo3the $aseline $efore returning tothe original 3aveform5

(hec dynamic flush after ?eroingany pressure tu$ing system


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TERIMAKA'ITERIMAKA'I

HH


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In#i"asiIn#i"asi

;.;. S*#)k state$seti) #r *+#v#le"i)S*#)k state$seti) #r *+#v#le"i)


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/$at is !eing/$at is !eing

easure# &easure# &

;.;. /entral ven#!s ress!re/entral ven#!s ress!re


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;.;. O(tain vital si'ns an% instit!te -/1O(tain vital si'ns an% instit!te -/1

"#nit#rin'"#nit#rin'


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Te,$ni0ue o1 insertionTe,$ni0ue o1 insertion

2*ont3#42*ont3#4

;.;. T*e tran%!)er are Mer)e% )ali(rateT*e tran%!)er are Mer)e% )ali(rate


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Te,$ni0ue o1 insertionTe,$ni0ue o1 insertion

2*ont3#42*ont3#4

5.5. T*e (all#n is t*en %eate% an% a PAT*e (all#n is t*en %eate% an% a PA

tra)in' Fill aeartra)in' Fill aear

6.6. T*e tran%!)er are la)e% at t*eT*e tran%!)er are la)e% at t*e

ri'*t atrial level. Hae"#%+na"i)ri'*t atrial level. Hae"#%+na"i)

"eass!re"ents an% t*er"#%il!ti#n"eass!re"ents an% t*er"#%il!ti#n

)ar%ia) #!t!ts are er#r"e% an%)ar%ia) #!t!ts are er#r"e% an%

%erive% varia(les )a)!late%%erive% varia(les )a)!late%

C.C. /R s*#!l% (e #(taine%/R s*#!l% (e #(taine%


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Measureent o1 ,ar#ia,Measureent o1 ,ar#ia,

output using %A*output using %A*;.;. -ns!re )#rre)t #siti#nin' # t*e PA/ in t*e-ns!re )#rre)t #siti#nin' # t*e PA/ in t*e

*eart* r#%i"al #enin' in R. ventri)le an%*eart* r#%i"al #enin' in R. ventri)le an%%istal t*er"ister ini !l"#nar+ aretr+%istal t*er"ister ini !l"#nar+ aretr+

6. monitoring hemodinamik1.ppt

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