The American Heart Association Task Force on Clinical Privileges in Cardiology has published a set of guidelines for defining clinical competence in hemodynamic monitoring ¹. These guidelines are reproduced below.

1. Knowledge of indications with emphasis on the subtleties involved. Data obtained should be needed to make management decisions and improve patient outcome. Obtaining high quality hemodynamic data, even though abnormal and sometimes contrary to clinical judgment, does not constitute an adequate indication.

2. Knowledge of the anatomy of the neck, central venous system, peripheral and arterial tree, heart, and lungs.

3. Knowledge of and ability to recognize pulse waveforms for the wide array of hemodynamic conditions for which the procedures are indicated.

4. Knowledge of and ability to perform the hemodynamic calculations that are possible and necessary (e.g., cardiac output, peripheral and pulmonary vascular resistance, and derived measurements such as stroke volume, ventricular stroke work).

5. Understanding the importance of and ability to recognize artifacts, clinical circumstances under which data may be misleading and/or difficult to obtain (e.g., situations when pulmonary capillary wedge pressure does not appropriately reflect left ventricular end-diastolic pressure or effect of pulmonary ventilation/ventilators on measurements).

6. Knowledge of fluid and electrolyte balance and their roles in altered hemodynamics.

7. Knowledge of the pharmacologic effects of the drugs that alter preload, afterload, and inotropic state.

8. Knowledge of the complications of hemodynamic monitoring and appreciation of the approaches and techniques necessary to minimize their occurrence, recognize their presence, and treat them promptly.

9. Knowledge of the interaction of multiple pathophysiologic states and diseases that are present in many critically ill patients undergoing hemodynamic monitoring.

10. Knowledge of the importance of an approach to assessing blood gases, pulmonary ventilation, and metabolic derangements.

11. Ability to communicate and document the results of the examination to the patient, to the medical record, and to other physicians.

The complete document is available on the world-wide web at: http://www.acc.org/clinical/competence/690002.htm

1. American Heart Association Task Force on Clinical Privileges in Cardiology. Clinical competence in hemodynamic monitoring. J Am Coll Cardiol 15:1463, 1990

Last edited on: 14/11/2000