I don't know if it's lack of enthusiasm or brilliant good sense, but the Docs here don't put in many Flow-directed, balloon tip'd, pulmonary artery catheters anymore. Studies show that long term monitoring of PAP/PCWP isn't all that benificial to the patient. If you ever ruptured a pulmonary artery neither you nor the patient is going to have a good day. With the advent of sophisticated echocardiography, most of the info obtained from the Swan can be calculated from the echo. Don't get me wrong, I still think that it is a valuable tool. I work in the Cath Lab from time to time and we still do RHC procedures and calculate CO/CI, systemic and pulmonay resistance, along with valve areas and gradients. The key is we get our sample pressures and get out. I just don't think that the risk justifies the benefit for long term PAP monitoring.
O_S
We have commented occasionally in the MICU about the relative lack of Swans as well. It is sometimes doc dependent, but for the most part, the PA cath has gone by the wayside. Infection risk just isn't worth it for the few numbers we get that nobody looks at or cares about anyway.
For those of you wondering what a Swan Ganz catheter is, Medline Plus Medical Encyclopedia (National Library of Medicine) has an explanation with a few pictures as well.
"Swan-Ganz catheterization involves the passage of a catheter into the right side of the heart to obtain diagnostic information about the heart and to provide continuous monitoring of heart function in critically ill patients."
http://www.nlm.nih.gov/medlineplus/e...cle/003870.htm
Andrew Lopez, RN
http://www.4nursing.com
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grapejam88 said:
. . . few numbers we get that nobody looks at or cares about anyway.
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That's really a good point. How many ICU nurses really understand hemodynamics these days. I personally used SVRI to gauge effect to afterload when I would be doing Dobutrex/Nipride titration (pre-enalapril days obviously). PAEDP with the low alarms set, on shocky septic patients that we were fluid resusitating. And I'd watch the wedge pressure when starting a patient on Primacor. Now that was cool to just watch that number just start dropping. If the truth be told, I really liked swans but it seemed like no one else did.
O_S
I have not touched a Swan in at least 5 years. We insert TLC and do CVP's now. I think our Swan kit has dust on it now!!!
DMyers
:houra: If it is to be. It is up to us as nurses. We need to stand together and not point fingers. We need to help each other for the good of our patients.
We utliize the CVP to guide fluid balance in my ICU as well and for the most part, it's adequate. We drive pressors off of cuff pressures too, sometimes several drugs at once which troubles me especially when the patient has vascular disease. We really should use arterial lines. I struggle at times with the resistance to diagnostic use of PA catheters especially when we really aren't sure just what the true fluid status is and when there is renal failure involved. When we do use them, it's short term which is appropriate; float the Swan, see the pressures do the calcs and get out.
R
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