Abstract

Continuous blood pressure monitoring is essential for intraoperative hemodynamic management, particularly in patients with cardiovascular comorbidities or procedures associated with significant hemodynamic shifts. Invasive arterial catheterization remains the standard for continuous monitoring but carries risks including infection, thrombosis, and hematoma. The ClearSight system (Edwards Lifesciences) is a noninvasive finger-cuff device that provides continuous beat-to-beat blood pressure monitoring using a volume clamp method. This case involved a 67-year-old female with multiple cardiovascular and metabolic comorbidities undergoing revision shoulder arthroscopy in the beach chair position who refused preoperative arterial line placement. Multiple post-induction attempts were required to obtain invasive access, resulting in approximately fifteen minutes of untreated hypotension. This delay prompted evaluation of whether noninvasive continuous monitoring with the ClearSight system could optimize intraoperative hemodynamic management.

Mean arterial pressure (MAP) is the primary determinant of end-organ perfusion, with intraoperative hypotension defined as MAP <65 mmHg. Even brief hypotensive episodes are associated with increased risk of myocardial injury, acute kidney injury, and postoperative mortality. Evidence demonstrates strong correlation and trendability between ClearSight-derived MAP and invasive arterial measurements across diverse surgical populations, meeting Association for the Advancement of Medical Instrumentation accuracy standards for MAP. Although systolic and diastolic measurements show greater variability, MAP remains reliable for real-time hemodynamic trending and vasoactive medication titration.

The ClearSight system offers advantages including rapid setup, avoidance of cannulation-related risks, improved patient comfort, and earlier access to continuous hemodynamic data. While invasive arterial monitoring remains the gold standard when absolute accuracy or blood sampling is required, the ClearSight system represents a valuable alternative or interim strategy when invasive access is refused or delayed. Incorporating noninvasive continuous monitoring may reduce the duration of unrecognized hypotension and enhance intraoperative patient safety.

Author Details

Samantha Hope Gladstein, DNP(c), BSN; Amy Snow, DNP, CRNA

Sigma Membership

Non-member

Type

DNP Capstone Project

Format Type

Text-based Document

Study Design/Type

Case Study/Series

Research Approach

Translational Research/Evidence-based Practice

Keywords:

Continuous Blood Pressure Monitoring, Mean Arterial Pressure, MAP, Hemodynamic Management, ClearSight System

Advisor

Terri M. Cahoon

Second Advisor

Amy Snow

Degree

DNP

Degree Grantor

Samford University

Degree Year

2026

Rights Holder

All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record. All permission requests should be directed accordingly and not to the Sigma Repository. All submitting authors or publishers have affirmed that when using material in their work where they do not own copyright, they have obtained permission of the copyright holder prior to submission and the rights holder has been acknowledged as necessary.

Review Type

None: Degree-based Submission

Acquisition

Self-submission

Date of Issue

2026-01-21

Full Text of Presentation

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Abstract.pdf (157 kB)
Detailed Abstract

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