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Pulmonary artery catheters (PAC) have become controversial for routine use, and many studies are showing the benefits don't outweigh the risks (Gupta & Mishra, 2017). However, hemodynamic monitoring (HDM) is still needed for fluid resuscitation and continuous measurements (Gupta & Mishra, 2017). Minimally invasive technologies, such as an arterial line and Vigileo, are widely available, but these still have limitations and risks for complications. Recently, multiple companies have released non-invasive HDM devices. These eliminate the complications and risks from invasive lines, while still producing vital circulatory measurements. The science behind each device varies slightly. In general, a finger cuff inflates, which puts pressure on the radial artery, and this is sensed by infrared light sensors to give cardiac output readings (Li et al., 2018). Please see the video on the right for further information and an animation of the technology.

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(Edwards Lifesciences Clinical Education, 2018)

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Decreased risk of infection

Less irritating and painful for the patient

Less complications, like thrombus, pneumothorax, arrhythmias, air embolism, and hematomas

Can be used in settings where HDM would be useful but in the past was too invasive, like in high risk surgeries (Nicklas & Saugel, 2017).

Quick and easy to set up and use

No possibility of needlestick injury  to the healthcare professional (Kuster, Exadaktylos, & Schnüriger, 2015).

Can be applied and used sooner than invasive HDM, such as in the emergency department and on floor units before transfer to ICU (Kuster et al., 2015)

Great for patient populations where invasive HDM wasn't an option, such as obese patients or the elderly ("ClearSight System," 2020).;

Portable and easy to transfer

Cost of machine is similar to the cost of a Vigileo or the Edwards monitor connected to a PAC.

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(Raut, Maheshwari, & Garg, 2012, figure 1)

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("Edwards ClearSight System," 2020)

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ClearSight™ System. (2020). Retrieved from https://www.edwards.com/gb/devices/Hemodynamic-Monitoring/clearsight

CNAP monitor [digital image]. (2020). Retrieved from https://www.cnsystems.com/products/cnap-monitor-500

Edwards ClearSight system [digital image]. (2020). Retrieved from https://www.edwards.com/devices/hemodynamic-monitoring/clearsight

[Edwards Lifesciences Clinical Education]. (2018, February 16). ClearSight technology overview animation [Video File]. YouTube. Retrieved from https://youtu.be/7rSXlT1RpK8

Gupta, A., & Mishra, S. (2017). Non-invasive cardiac output monitoring – To be or not to be, that is the question! Indian Heart Journal, 69(3), 293. doi: 10.1016/j.ihj.2017.05.028

Joosten, A., Desebbe, O., Suehiro, K., Murphy, L. S., Essiet, M., Alexander, B., … Cannesson, M. (2017). Accuracy and precision of non-invasive cardiac output monitoring devices in perioperative medicine: A systematic review and meta-analysis. British Journal of Anaesthesia, 118(3), 298–310. doi: 10.1093/bja/aew461

Kuster, M., Exadaktylos, A., & Schnüriger, B. (2015). Non-invasive hemodynamic monitoring in trauma patients. World Journal of Emergency Surgery, 10(1), 1–6. doi: 10.1186/s13017-015-0002-0

Li, M., Yang, L., Zhou, L., Liu, J., Patel, S., & Liu, H. (2018). Non-invasive cardiac output measurement: Where are we now? Journal of Anesthesia and Perioperative Medicine, 5(4), 221–227. doi: 10.24015/japm.2018.0076

Nicklas, J. Y., & Saugel, B. (2017). Non-Invasive hemodynamic monitoring for hemodynamic management in perioperative medicine. Frontiers in Medicine, 4. doi: 10.3389/fmed.2017.00209

Raut, M. S., Maheshwari, A., & Garg, V. (2012). Resistance to withdraw a Swan-Ganz catheter: A word of caution. Annals of Cardiac Anaesthesia, 15(3), 254–255. doi: 10.4103/0971-9784.97989

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"Extensive pulmonary edema, pleural effusion, valvular heart disease, dysrhythmias, extensive chest wall edema, and chest tubes parallel to the aorta can reduce the impedance measured by the device, and lead to false data" (Kuster et al., 2015).

Inaccurate data can occur from hyperventilation, anxiety, shivering, and frequent repositioning, but these factors can also cause inaccuracies in invasive HDM (Kuster et al., 2015).

Significantly less accurate than a PAC, but only slightly less accurate than an arterial line (Joosten et al., 2017).

Measurements may be less accurate in systemic sepsis and in patients receiving vasopressors (Li et al., 2018).

Have been studied mostly in perioperative patients and less in critically ill patients (Li et al., 2018).

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("CNAP monitor," 2020)

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There is no debate to the advantages of having a non-invasive HDM system within a hospital. There are numerous instances where a patient needs HDM, but can't because it's too invasive, will take too long, or access to an artery is not possible ("ClearSight System," 2020).  A system like this can assist with identifying and managing circulatory concerns early in treatment (Kuster et al., 2015). However, it is not as accurate as a PAC and can't take the place of PAC in every situation (Joosten et al., 2017). Since it isn't as accurate in patients on vasopressors or with conditions like pulmonary edema it shouldn't be the primary HDM system within ICU's (Li et al., 2018). However, it should be considered by hospitals for use when invasive and minimally invasive HDM isn't an option and in many perioperative situations (Nicklas & Saugel, 2017). In some ICU's almost no HDM is being implemented due to fear of complications. Non-invasive HDM would be useful in these ICU's to provide additional hemodynamic measurements to evaluate usual treatments and manage care.

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My 5 strengths: focus, communication, significance, harmony, achiever

My Teammates
- Faith - futuristic, will keep the team and users of the system focused on change being beneficial and improving the future.

- Andrew - Activator, will help get the project moving and not get caught up in fears or details that can set us back.

- Daisy - Developer, will help grow and support the team.

- Ivy - Individualization, will be able to understand each professional using the system, and focus on aspects of our system that they in particular will like.

- Shiela - Strategic, can create new strategies if we run into issues along the way.