Procedure for Set-Up of Hemodynamic Monitoring Circuit

INDEX

1. Assemble Equipment 
2. Prime Transducer
3. Pressurize system
4. Replace caps

PROCEDURE FOR SETUP OF HEMODYNAMIC MONIOTRING CIRCUIT

 1.

Assemble equipment:

1. 500 ml 0.9% normal saline with air removed from bag
2. Pressure bag (blood transfusion pump)
3. Transducer kit
4. Transducer holder (installed on IV pole)
5. PPE

NOTE: All CVC (IJ, SC, Femoral must be connected to pressure monitoring upon insertion and venous waveform confirmed before initiation of infusions. Once a venous waveform is confirmed, infusions may be initiated while awaiting  the chest Xray to rule out thoracic complications). Waveform confirmation must posted to the chart upon insertion, admission and at least once per shift.

Prepare and Prime the Transducer

1. Open transducer kit. Tighten all the connections and caps before removing from sterile package to prevent contamination.
2. The soft compliant tubing is used to deliver the flush solution.  The hard non-compliant tubing is connected to the patient's vascular device. This tubing prevents waveform distortion through stretching or kinking of the tubing.
3. Close the roller clamp on the infusion tubing, then spike the saline bag.  Do not prime yet.
4. Hang saline bag on the IV pole and snap the transducer into the transducer holder. Use the colored dots provided in the transducer kit to identify the type of line being measured (arterial (red), CVP (blue), pulmonary artery (yellow).
5. Do not pressurize the saline bag at this point. Prime without pressure to minimize air bubble formation.
6. Open the roller clamp, partially squeeze the drip chamber, close the roller clamp and release the drip chamber (OSCAR - Open, Close, Squeeze and Release). 
   Avoid squeezing the drip chamber fully. The goal is to fill the drip chamber to the minimum level; when the saline is pressurized the drip chamber will rise. Ideally, maintaining a fluid level in the drip chamber allows for visualization of the quality of flushing after blood sampling
7. Open the venting stopcock to air (turn the stopcock located above the transducer off to the hard pressure tubing).  This will open the system between the saline back and the vent port.
8. Pull the flush device to prime the infusion tubing. Flush until all air bubbles have been eliminated through the vent port.
9. Turn the stopcock off to the vent port to open the flow between the saline bag and the pressure tubing. 
10. Make sure the stopcock in the extension tubing (sampling stopcock) is closed to the sampling port.   
11. Pull the flush device to prime the pressure tubing.
12. Turn the sampling stopcock toward the distal end of the tubing to flush the sampling port.
13. When the entire system is fully flushed, turn the sampling stopcock off at 45 degrees. This position is off in all directions, which will prevent leakage or air entry into the primed system.

 3.

Pressurize Saline and Connect Transducer to Monitor

1. Ensure that all pressurized infusions are on an IV pole that is not attached to the articulating arm and at least 1 meter away from electrical outlets.
2. Pressurize the bag of saline to the maximum pressure.
3. Connect the pressure cable to a pressure module
4. Activate the pressure module and assign the correct label
   Refer to Overview of Monitoring Hardware and Configuration for instructions to enable modules.
5. Adjust the transducer until the vent port on the venting stopcock is level with the mid axillary line.
6. Turn the venting stopcock off to the pressure tubing (open to the vent port).  The white cap is a vented cap, therefore, it can be left in place.
7. Zero the bedside monitor.  
8. Wait until the pressure falls to zero (both the numerical value and the location of the waveform on the scale).
9. If the monitor does not find zero, repeat the process.
10. If the transducer does not zero, replace the transducer and leave for biomedical to evaluate and obtain a refund.
11. Turn the venting stopcock off to the vent port. 

 4.

Replace all Caps

1. Replace the luer-lock cap on the venting stopcock with a dead-end cap (provided in package)
2. Replace the vented cap on the sampling stopcock with a needleless access device.
3. Cover the needleless access device with an antiseptic luer-lock cap
4. Inspect the system for any small air bubbles, including over the transducer. Perform additional flushing if required.
5. Leave the sampling stopcock off at 45 degrees
6. The system is ready to connect. The system should be releveled once it is connected to the patient catheter.

Elimination of air will prevent air bubbles from being pressurized into the circuit. Even tiny air bubbles can interfere with pressure measurement accuracy.

Tapping of the transducer may be required during flushing to clear bubbles trapped over the transducer.

Larger air bubbles carry the risk of air embolism to distal organs (limb or lung, depending upon whether it is a venous or arterial catheter).