Equipment
- Pressure bag able to inflate to 300 mmHg
- 500 mls Saline solution with iv additives label:
- Consider adding 500 iu heparin (document in chart if given)
- 2 ml syringe and green needle
- 1000 units refrigerated heparin
- Two pressure modules with pressure cables
- Single or dual transducer set (comes complete with giving set) with transducer holder (if available)
- Suitable cardiac monitor with invasive pressure monitoring
- Gloves
- Narrow width tape
Procedure
- Gather equipment together
- Test integrity of pressure bag (check for leaks, breaks, faulty dial…)
- Insert the pressure modules into the cardiac monitor by clicking them in place (for CVP monitoring, both modules will still be required)
- Apply gloves; check and draw up the heparin (complete an iv additives label)
- Add the heparin to the saline solution and shake well
- Attach the transducer set and prime
- Connect the saline to the pressure bag
- Ensure the saline rests in the centre of the pressure bag
- Inflate the pressure bag as it rests on the counter
- Inflate to 300 mmHg
- Hang the pressure bag up
- Take care to close all ports open to air when priming lines
- 'Squeeze' the fluid through the lines (using the blue and red flush valves)
Arterial line
- Connect the arterial tubing (red) to the patient’s arterial access
- Connect the white pressure cable inserted in the first pressure module to the white transducer cable
- To zero, turn the white tap ‘off’ to the patient, i.e., in the direction of the patient, and open the orange port to air
- Press zero on the arterial pressure module. Hold it down until the monitor states ‘arterial zero done’
- Turn the white tap ‘off’ to air and close the orange port
- Ensure arterial access site remains visible at all times
- Using tape and a red pen, label the arterial line clearly with the letters 'ART'
CVP line
- Ensure CVP line stitched in, flushed through and secured with tegaderm
- Connect the white CVP connector to monitor
- Connect the grey pressure cable inserted in the second pressure module to the white transducer cable
- To zero, turn the white tap ‘off’ to the patient and open the orange port to air
- Press zero on the CVP pressure module. Hold it down until the monitor states ‘CVP zero done’
- Turn the white tap ‘off’ to air and close the orange port
- Secure the ‘red’ and ‘blue’ flush valves at the level of the patient’s right atrium
- Tape them, if necessary to the patient's mid upper arm, at the level of the heart
Re-zero
Re-zero the arterial and/or central venous pressures if:
- The equipment becomes disconnected in any way
- The patient’s position alters
- Monitoring is transferred to a different machine, i.e., for transfers