Bridging the gap between hemodynamics and monitoring

Hurst states that "hemodynamic monitoring is a complement of, rather than a replacement for, clinical judgment." Holder explains that "hemodynamic parameters add sufficient clarity for physicians to a difficult patient management problem." However, it is nursing which must bring clarity to the parameters. It is the nurse who must be ever-vigilant and strive for excellence in invasive hemodynamic monitoring of critically ill patients--as the caregiver who is with the patient 24 hours a day, 7 days a week. Effective hemodynamic monitoring starts with an understanding of the hemodynamic mechanisms that monitoring aims to measure. Then, measuring the hemodynamic mechanisms requires technical expertise to provide accurate parameters from the monitoring equipment. Lastly, an appreciation for the risks and benefits, together with patient responses to being monitored, helps the nurse evaluate the contribution invasive hemodynamic monitoring has on patient outcomes. Nurses who couple knowledge of cardiovascular physiology, technical expertise, and thorough assessment and diagnosis of patient responses to hemodynamic instability and invasive monitoring bring the essence of holistic nursing care to hemodynamic monitoring.