Hemodynamic Stability: The Key to Patient Safety

Nurses play an important role in ensuring the safety of their patients. One key aspect of patient safety is hemodynamic stability. This term refers to the condition of a patient’s blood pressure and heart rate. Maintaining hemodynamic stability is essential for preventing complications and ensuring that patients receive the best possible care. In this blog post, we will discuss what hemodynamic stability is, why it is important, and how nurses can ensure that their patients remain stable.

Table of Contents

What is hemodynamic stability and why is it important?

Hemodynamic stability refers to the condition of stable blood flow throughout the circulatory system. If a patient is called hemodynamically stable, it means that he or she has a stable heart that is pumping and good circulation of blood throughout the system. This is important because it helps to ensure that oxygen and nutrients are being delivered to all the organs and tissues of the body. It also helps to prevent complications such as organ damage, stroke, and heart attack.

What are the 4 parameters/criteria of hemodynamic stability?

There are four main parameters that are used to assess hemodynamic stability: heart rate, blood pressure, stroke volume, and cardiac output. To be considered hemodynamically stable, a patient must have:

  • Heart Rate: A heart rate that is within a normal range for the individual. Depending on which node within the heart is working will determine the normal range for the heart rate. If the SA Node is the primary pacemaker, the heart rate should be 60-100 BPM. If the AV Node is the primary pacemaker, the heart rate should be 40-60 BPM. If the Purkinje fibers are the only pacemaker working, the heart rate should be between 20-40 BPM.
  • Blood Pressure: A blood pressure that is within a normal range for the individual. The normal range for blood pressure varies depending on age, gender, and other factors. However, a general range for blood pressure is considered to be 120/80 mmHg. You also want to ensure you have a Mean Arterial Pressure (MAP) of greater than 60 mmHg (greater than 65 is better).
  • Stroke Volume: A stroke volume that is within a normal range for the individual. The stroke volume is the amount of blood that is pumped out of the heart with each beat. The normal range for stroke volume varies depending on age, gender, and other medical factors. However, a general range for stroke volume is 50-100 mL/beat.
  • Cardiac Output: A cardiac output that is within a normal range for the individual. Cardiac output is the amount of blood that is pumped out of the heart in one minute. The normal range for cardiac output is considered to be between 4 and 8 liters per minute.

Hemodynamic Instability Causes and Symptoms

If a patient is known to have hemodynamic instability this means that their blood pressure or heart rate is not adequate to provide blood flow to organs. This can happen for a variety of reasons, including dehydration, sepsis, and bleeding. When hemodynamic instability occurs, it is a medical emergency and nurses must take immediate action to stabilize the patient. This may include administering fluids or medications, performing CPR, or using a mechanical ventilator.

How to assess hemodynamic stability and perfusion

There are a few ways to assess hemodynamic stability and perfusion.

Check the patient’s pulse: This can be done by feeling for a pulse on the neck, wrist, or groin. Does the pulse reflect what is being shown on the monitor? Is the heart rate within the defined parameters from where it is originating?

Check the patient’s blood pressure: This can be done with a manual or electronic sphygmomanometer. Again, is the blood pressure within the defined parameters?

Check the patient’s skin color and temperature: Is the skin pale or mottled? Is the skin temperature cool to the touch?

Check the patient’s stroke volume: Stroke volume is calculated by looking at a number of factors including preload, afterload, and contractility.

  • To assess preload, look at the patient’s filling pressures (i.e. left arterial pressure LAP). The greater the preload the greater the volume of blood in the heart will be at the end of diastole.
  • Afterload is the amount of resistance the heart has to pump against. This can be assessed by looking at the systolic blood pressure. The higher the afterload, the harder the heart has to work to pump against it.
  • Contractility is how well the myocardium (heart muscle) is able to contract. This can be measured by looking at the ejection fraction (EF). The EF is the percentage of blood that is ejected from the ventricle with each beat. A normal EF is between 50-75%.

If any of these signs are not within normal, it may indicate that the patient is not receiving adequate perfusion and is therefore either becoming or is hemodynamically unstable.

How nurses can ensure their patients remain stable

There are a few things nurses can do to ensure their patients remain hemodynamically stable.

Monitor vital signs frequently: This includes monitoring the patient’s heart rate, blood pressure, respiratory rate, oxygen saturation (SpO2), cardiac output, etc.

Assess for signs of inadequate perfusion: This includes assessing skin color, temperature, capillary refill time, mental status, level of consciousness, etc.

Administer fluids and medications as prescribed: This may include administering IV fluids, blood products, or medications such as vasopressors or inotropes. You will also need to use your clinical judgment regarding how much fluid is too much fluid for patients who may have underlying health conditions such as heart failure.

Monitor labs: This includes monitoring hemoglobin and hematocrit levels, as well as serum electrolytes.

Advocate for your patient early: If your patient starts to exhibit signs of becoming hemodynamically unstable, it is important to act quickly and advocate for your patient. This means calling for help from the Rapid Response Team or Code Blue Team, as well as getting your patient to the operating room for surgery if necessary.

The most important thing for nurses to remember is that hemodynamic instability is a medical emergency. By remaining vigilant and taking quick action, we can ensure that our patients remain stable and receive the care they need.

The role of technology in maintaining hemodynamic stability

There are a number of ways that technology can help maintain hemodynamic stability. However, technology also has its faults and there are always potential risks associated with its use. It is important that you always treat your patient and not the monitor.

One of the ways technology can help is by providing nurses with real-time data about their patients’ vital signs. This data can help nurses catch any potential problems early and take quick action to correct them.

This is achieved by using hemodynamic monitoring devices. These devices can help continuously monitor a patient’s vital signs and alert nurses to any changes. Examples of things you may see in critical care are:

  • ECG Monitoring Devices: These devices can help monitor a patient’s heart rate and rhythm. It also provides important information such as ST segment changes that could signal either ischemia or infarction in the heart.
  • Central Venous Pressure Devices: These devices measure the pressure in the central veins. This information is important because it can help guide fluid resuscitation and help prevent over-resuscitation.
  • Arterial Pressure Monitoring Devices: These are placed in an artery and help measure blood pressure. This information is important because it can help guide rapidly changing clinical circumstances in critically ill patients (i.e. hemorrhage, sepsis); monitor and guide vasoactive drugs with rapid cardiovascular effects (such as inotropes and vasopressors); monitor and guide acute interventions (i.e. major surgery, resuscitation); and can also be used for blood sampling.
  • Pulmonary Artery Catheter Monitoring Devices: These devices measure the pressures in the pulmonary arteries and help guide fluid resuscitation, as well as monitor for signs of heart failure. These devices can also assist with diagnosis and therapy for post-myocardial infarction, cardiac surgery, major surgery, septic shock, fluid resuscitation, pulmonary edema, and eclampsia patients.

There are many devices that can help monitor a patient’s hemodynamic status and these examples are just a few of the devices you may see routinely depending on your specialty. It is important to remember that technology is not perfect and there are always potential risks associated with its use.

Hemodynamic instability and tube feeding, enteral nutrition, dialysis

Tube feeding, enteral nutrition, and dialysis are all therapy modalities that can help maintain hemodynamic stability in critically ill patients. However, there is a lot of discussion about the appropriate use of these modalities when patients are on any kind of vasopressor support.

  • Tube feeding is a method of delivering nutrition directly to the stomach or small intestine. This can be done either nasally or orally.
  • Enteral nutrition is a type of tube feeding that delivers nutrients directly to the stomach or small intestine. This is usually done via a nasogastric or gastrostomy tube.
  • Dialysis is a method of removing waste products and excess fluid from the blood. This can be done with either hemodialysis or peritoneal dialysis. For patients who are unable to tolerate these forms of dialysis due to hemodynamic instability, Continous Renal Replacement Therapy (CRRT) is an alternative.

There is a lot of debate about the appropriate use of these modalities in critically ill patients on vasopressor support. Some experts feel that these modalities are contraindicated in patients on vasopressor support due to the risk of mortalities. It is also said that vasopressor medications impede the blood flow to the gastrointestinal system but the research is still incomplete. Other experts feel that these modalities can be used safely in patients on vasopressor support if certain precautions are taken, such as careful monitoring of tolerance of feedings with high doses of IV vasopressors and signs of bowel necrosis.

There is also a fine line between hemodynamic stability and dialysis. If a patient is too unstable for dialysis, CRRT may be a better option. CRRT can be done with lower doses of vasopressors and is less likely to cause gastrointestinal bleeding.

The bottom line is that there is still a lot of debate about the appropriate use of these modalities in critically ill patients on vasopressor support. More research is needed to determine the best course of action for each individual patient.

What do you think? Do you have any experience with using these modalities in critically ill patients on vasopressor support? Let me know.

The future of hemodynamic stability in nursing care

As technology advances, there will likely be even more ways that nurses can use it to help maintain hemodynamic stability. It is important to stay up-to-date on the latest technology and devices so that you can provide the best possible care for your patients.

One of the newest areas of research is the use of artificial intelligence (AI) to help monitor patients. AI has the potential to provide even more real-time data about a patient’s condition. This could potentially help nurses catch problems even sooner and provide more targeted care. You see this a lot with the new charting systems that have built-in algorithms to determine patient risks for deterioration, sepsis, and readmissions.

AI is still in the early stages of development, but it has great potential to help nurses provide even better care for their patients. It will be exciting to see how AI develops in the coming years and how it can be used to improve patient care.