Quality Assurance in Hemodynamic Monitoring

Abstract

Patient care management decisions frequently are based, at least in part, on hemodynamic indices. Accuracy in repeated measurement of hemodynamic parameters is therefore critical. It can be achieved only through a program of quality assurance (QA), which should include the following factors: static, dynamic, and validation of pulmonary artery wedge pressure (PAWP). The static QA factor consists of establishing an accurate reference point from which all subsequent measurements are made. The hemodynamic monitoring system must be able to transmit pulsating physiologic pressures to the transducer with high fidelity, which is validated via the dynamic response or "square wave" test and damping coefficient. Other QA aspects that are used to validate the accuracy of PAWP include catheter placement into lung zone 3 capillary and comparison of capillary to arterial blood gases. Measurement error also can be introduced because of varying methods to quantify the ana-log pressure waveforms, such as end-expiratory or pressure averaging techniques. This paper explores each of these domains within a framework of quality assurance.