NTI 2018 / American Association of Critical Care Nurses

Boston Convention & Exhibition Center (BCEC)
415 Summer St., Boston, MA 02210

May 22-24, 2018

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Speaker Bios

Kathryn T. Von Rueden, RN, MS, ACNS-BC, FCCM — Critical Care Consultant

With multiple awards, including the 2015 AACN Circle of Excellence Award, Kathryn is a distinguished author and lecturer with extensive experience in cardiovascular care and sepsis management.

Barbara “Bobbi” Leeper, RN, MS, ACNS-BC, FCCM — Critical Care Consultant

Bobbi is an award-winning author and lecturer in the critical care space and recipient of the 2011 AACN Flame of Excellence Award.

Jan M. Headley, RN, BS — Principal, Consultants in Acute and Critical Care

An award-winning, nearly forty-year member of AACN, Jan lectures and publishes extensively on cardiovascular, hemodynamic, and oxygenation concepts and applications.


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Presentation Highlights

Why Using EBP Is Critical When Caring For Patients With Pulmonary Artery Catheters
Kathryn T. Von Rueden RN, MS, ACNS-BC, FCCM

The accuracy of pressure readings from pulmonary artery catheters (PAC) is dependent upon the integrity of the monitoring system and the techniques used in obtaining the measurements. This presentation will include a discussion of the mechanical and physiological influences on obtaining accurate hemodynamic parameters. The AACN Practice Alert for Pulmonary Artery and Central Venous Pressure Monitoring is used as an evidence-based foundation for optimal practice. This session also reviews normal waveforms changes from the right atrium to the pulmonary artery wedge (occlusion) catheter position for use in PAC troubleshooting.

Making the Case for Hemodynamic Assessment and Management in Various Shock States
Kathryn T. Von Rueden RN, MS, ACNS-BC, FCCM

Cardiogenic, hypovolemic and septic shock are not uncommon in critically ill patients and can have devastating consequences. Understanding the pathophysiology of these types' shocks improves the interpretation of hemodynamic parameters that clinically are used to diagnose and manage shock. Using a case study approach, this session reviews the hemodynamic response to the pathophysiology of cardiogenic, septic and hypovolemic shock and utilization of hemodynamic monitoring technologies to assess, manage, and evaluate the response to therapy in various shock states.

Why Monitor Hemodynamics in Cardiac Surgery and Heart Failure Patients
Barbara Leeper, MN, RN-BC, CNS M-S, CCRN, FAHA

Hemodynamic monitoring plays an important role in the management of today's critically ill cardiac patient. Hemodynamic parameters can assist with identification of the underlying pathophysiological processes and direct the management of the patient. Secondly, monitoring allows preemptive interventions to occur before a significant problem occurs. While there are many hemodynamic monitoring technologies available today, this session will focus on the basics of advanced monitoring including hemodynamic data from pulmonary artery catheters and mixed venous oxygen saturation. The purpose of this interactive session is to demonstrate the usefulness of the hemodynamic data using case examples. A case will be presented and attendees will be invited to interpret the data and use their clinical judgment to identify the potential problem and recommend an appropriate intervention.

Missed Events: The Why of Monitoring Continuous Venous Oximetry
Barbara Leeper, MN, RN-BC, CNS M-S, CCRN, FAHA

Patients admitted to critical care units have multiple co-morbidities and are at higher risk for adverse events. Some of our nursing interventions can impact their outcomes by disrupting their tissue oxygen supply and demand balance. The purpose of this interactive session is to discuss how continuous venous oximetry contributes to the decision making a process for nursing interventions. The impact of nursing interventions on oxygen demands and subsequently venous oximetry will be presented. A comparison of mixed venous and central venous oxygen saturation will be demonstrated. Case exemplars will be used to demonstrate specific points.

What Goes In - Should Come Out: Why Fluid Balance Is Important
Jan M. Headley, RN, BS

Fluid therapy remains a mainstay for resuscitation of patients in shock. Once initial hypotension is corrected with fluid, additional fluid administration may prove detrimental and more so in specific patient conditions such as sepsis, acute renal injury, and acute lung injury. During the various phases of resuscitation; rescue, optimization, stabilization, and de-escalation, there is evidence-based rationale for specific hemodynamic targets and interventions. This session focuses on the various phases and how best to develop an individualized therapeutic intervention strategy. A rationale for accurate and precise fluid measurement is presented.

Invasive vs. Noninvasive, Catheter vs. Cuff Pressure: Why Differences Are Important To Know
Jan M. Headley, RN, BS

Blood pressure (BP) remains one of the most used parameters in patient assessment. Optimal pressure monitoring systems are required to obtain accurate invasive arterial blood pressure (IABP). Proper cuff size and placement is required for non-invasive blood pressure (NIBP). Both methods require accurate leveling. IABP is considered the 'gold standard', however, the use of NIBP is more frequently employed. Research comparing the two methods has shown a significant discrepancy between the values outside the normal BP range indicating that the two methods are not interchangeable. However, newer non-invasive continuous monitors have shown excellent correlations with invasive means. Therefore, acute care patients who do not have an invasive arterial line but require continuous assessment can now be monitored. AACN's PAP and CVP and NIBP Practice Alerts provide excellent evidence-based foundations for ensuring optimal practice.