Criteria for insertion of invasive monitors-rules of thumb

Arterial Catheterization: Criteria for Insertion

for ABG's

Respiratory insufficiency necessitating three or more arterial blood gas determinations

Arterial acidemia necessitating three or more pH determinations

for BP monitoring

Severe hypotension as defined by:

systolic BP 30% below the patient's normal pressure

a BP requiring intervention with more than 1 fluid bolus or 10 ml/kg or requiring multiple administrations of pressor agents

Hypertension as defined by

a systolic BP 30% above the patients normal pressure

a blood pressure likely to require or requiring intervention with repeated (>2) doses of antihypertensives or a constant infusion of antihypertensive medications

Frequent laboratory draws

Cardiopulmonary bypass

Induced hypotension

Patient with severe coronary or cerebral disease requiring close observation

Expected blood loss likely to compromise hemodynamic stability

Central Venous Catheterization: Criteria for Insertion

Central Venous Monitoring

Hypotension (>30% decrease below patient's normal blood pressure) in which intravascular volume status is unclear

Oliguria (<0.5 ml/kg/hr urine output) in which intravascular volume status in unclear. This includes patients in whom urinary tract (G.U.) interruption prevents evaluation of volume by means of urine output

Injury and/or surgery in which blood and/or third-space loss is expected to be >20% of patients blood volume

Air embolism or risk of air embolism

Intravascular Access needed for

Administration of hypertonic solution such as Dextrose concentration in excess of 12.4%

Administration of IV and /or medications when attempts at peripheral sites have failed after at least three attempts

Immediate emergent access when peripheral sites are not obviously present

Pulmonary Artery Catheterization:

Severe cardiovascular instability, including ischemia, cardiac failure, and LV dysfunction

Significant ARDS, use of PEEP > 10 cm

Anticipated large fluid shifts or bleeding during elective surgery

Aortic surgery requiring cross clamping

Use of Bicarbonate (should be guided by arterial blood gases)

pH < 7.2 with a pCO2 of 40 or less

Acidemia associated with myocardial depression

Bicarbonate less than 15 mg/L regardless of pH

Bicarbonate contraindicated if sodium > 150 or to correct respiratory acidosis

Life-threatening hyperkalemia until K+ corrected, with calcium