Invasive intravascular hemodynamic monitoring: technical issues

There is a lot of discussion in the literature about the best way to manage hemodynamic problems, but no algorithm can be useful unless the hemodynamic measurements that are used in the algorithms are valid. Yet, studies repeatedly have shown that physicians and nurses do not have a strong knowledge of the principles of measurements. Key factors in the use of transducers are zeroing, leveling, and calibrating. An understanding of the concept of transmural pressure is key to avoiding many potential artifacts related to variations in pleural pressure. The location of the proper place for measurement on the actual waveform can also be a source of error. This article covers these points as well as some suggestions for trouble-shooting.