3) ACCN Pre-Reading - Haemodynamic Waveforms - Part 1

Hospital Authority, Institute of Advanced Nursing Studies
ACCN Course, 2008
Pre-Workshop Reading materials (3)
Haemodynamic Waveforms
Interpretation – Part I
ACCN Course Instructors

David CHAN, NS/ICU/PWH
SO Hang Mui, NS/ICU/PYNEH
MAK Wai Ling, NS/ICU/YCH & PMH 1
A) Haemodynamic Waveforms
1. Arterial Pressure Waveforms
2. CVP Waveforms
3. PA / PCWP Waveforms
B) Pacing waveforms
C) IABP waveforms
2
1) Arterial Pressure Waveforms
3
Components of the Arterial Pulse
Peak Systolic Pressure
Dicrotic Notch (AV Closure)
Diastolic Pressure
Anacrotic Notch (Presystolic wave – a rise before AV opening)
Pulse Pressure
2) Dicrotic notch
1) Systolic pressure (AV closure)
5) Pulse Pressure 4) Anacrotic Notch 3) Diastolic

e.g. 100/60 = 40 (AV opening) pressure 4
More central vessel
tends to undershoot
(overdamp) the
waveforms due to
lesser vascular
resistance
Usual radial
artery
waveforms
More distal vessel

tends to overshoot
(underdamp) the
waveforms due to
increase in vascular
resistance
(The dicrotic &

anacrotic notch of
peripheral pulse may
not be present.)
5
Regional differences of Pressure Waveforms
Radial, dorsalis pedis,

femoral arteries
Central arteries tend to
undershoot the
waveforms due to
decrease in vascular
resistance
Peripheral arteries tend to
overshoot the waveforms
due to increase in
vascular resistance
MAP should be the same.
6
Relationship of Arterial Pressure
Waveforms with ECG
The end-diastolic pressure of an arterial

pressure waveform correlates with the
end of QRS (J point) in more central
arteries.
7
The J point
meets the
end-diastole.
Central arterial wave (no delay) 8

Relationship of Arterial Pressure
Waveforms with ECG
The end-diastolic pressure of an arterial

pressure waveform correlates with the
end of QRS (J point) plus a
conductional delay (e.g. 0.2 sec) in
more peripheral arteries (due to the
distance of the arterial cannula site to
the heart).
9
The end-diastole
delays from
the J point for
up to 0.2 s.
Peripheral arterial wave (with delay)

10
No dicrotic wave due
to long transmission
distance
Peripheral arterial wave 11

2) Leveling (Phlebostatic Axis)
Left atrium - reference point

on the chest
Used as a baseline for
consistent transducer height
placement.
Obtaining the axis involves
drawing a line from the fourth
intercostal space, where it
joins the sternum, to a mid-
axillary line.
The intersection of these lines
approximates the level of the
atria.
12
13
14
4) Ensuring accuracy of Pressure
Waveforms (Square Wave Test)
Other than comparing the cuff pressure with

the arterial pressure, the accuracy of pt’s BP
can be done by performing a Square Wave
Test (or Dynamic Response Test).
15
Overdamped = Undershooting
16
Underdamped = Overshooting
17
Procedure
Activate fast flush system to give a square wave output

Record the square wave and oscillations on a paper strip
2 steps to determine optimal damping :
1) Work out the Resonant frequency = Paper speed (mm/s) / distance
between 2 peaks of oscillations (mm).
2) Work out the Damping Coefficient = amplitude of second oscillation /
amplitude of the first oscillation.
18
1.5
Paper Speed : 25 mm/s

Distance between 2 amplitude : 1.5 mm
1) Resonant Frequency (Natural Frequency) : 25 / 1.5 = ~ 17
*****************************************************************
A2 = 3 mm; A1 = 7 mm
2) Damping Coefficiency : A2 / A1 = 3 / 7 = 0.4
19
Frequency response = 17
Damping coefficient = 0.4
So, the damping is adequate (Normal).
20
21
2) CVP Pressure Waveforms
22
Understanding a normal CVP waveform
a – atrial contraction
c – force exerted by closure of tricuspid valves due to right
ventricular contraction.
x – atrial relaxation
v – atrial filling
y – atrial emptying
23
a wave falls on PR intervals
24
Mean CVP = Mean value of ax wave, during end-expiration.
25
Factors that can lead to waveforms
misinterpretation
Large A wave – due to tricuspid stenosis

Large V wave – due to tricuspid regurgitation.
Respiratory Variation
26
27
28

3) ACCN Pre-Reading - Haemodynamic Waveforms - Part 1

Uploaded by

Copyright:

Available Formats

3) ACCN Pre-Reading - Haemodynamic Waveforms - Part 1

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

3) ACCN Pre-Reading - Haemodynamic Waveforms - Part 1

Uploaded by

Copyright:

Available Formats

Hospital Authority, Institute of Advanced Nursing Studies

ACCN Course, 2008

Pre-Workshop Reading materials (3)

ACCN Course Instructors

5) Pulse Pressure 4) Anacrotic Notch 3) Diastolic

More distal vessel

(The dicrotic &

Radial, dorsalis pedis,

The end-diastolic pressure of an arterial

Central arterial wave (no delay) 8

The end-diastolic pressure of an arterial

Peripheral arterial wave (with delay)

Peripheral arterial wave 11

Left atrium - reference point

Other than comparing the cuff pressure with

Activate fast flush system to give a square wave output

Paper Speed : 25 mm/s

Large A wave – due to tricuspid stenosis

You might also like