PAWP - page 2

Just curious, do very many facilities wedge anymore? I know this topic has been posted before, but it looks like the threads are several years old. We don't personally wedge at my hospital, but I'm... Read More

  1. Visit  marilynbaker} profile page
    1
    My hospital wedges...
    Esme12 likes this.
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  3. Visit  LNRN11} profile page
    0
    Completely agree w/ you, StayLost! We rarely use them because of the discrepancies. I had one a few months ago and my CT surgeon had me hook up a CO/CI injectate syringe and shoot an index. It was way off.
  4. Visit  Biffbradford} profile page
    0
    Haven't seen a wedge pressure used in years. In fact, most post op heart orders state: "do NOT wedge".
  5. Visit  Chisca} profile page
    2
    Wedging a PA catheter requires a degree of nursing skill that most nurses don't want to bother with. You have to know the waveforms and where in the EKG and respiratory cycle to measure, preferably after you have graphed the waveform on paper. It's usefull information but you have to know how to safely obtain it. Properly done it is an extremely safe thing to do. And even if you don't wedge you should know what the wave form looks like in case the catheter accidently advances to wedge.
    applewhitern and Esme12 like this.
  6. Visit  youngmalenurse} profile page
    0
    At my hospital we do not wedge because we lost a patient years ago due to this. Like many who have said before the EV 1000 monitor is standard at my facility.
  7. Visit  SummitRN} profile page
    0
    We can wedge in theory, but usually just use all the other swan numbers and waveforms. I've only seen a wedge once in our ICU, and it was a medical patient.
  8. Visit  Chisca} profile page
    1
    Esme12 likes this.
  9. Visit  Esme12} profile page
    0
    Quote from Chisca
    Wedging a PA catheter requires a degree of nursing skill that most nurses don't want to bother with. You have to know the waveforms and where in the EKG and respiratory cycle to measure, preferably after you have graphed the waveform on paper. It's usefull information but you have to know how to safely obtain it. Properly done it is an extremely safe thing to do. And even if you don't wedge you should know what the wave form looks like in case the catheter accidently advances to wedge.
    I find this mind boggling and so very sad......
  10. Visit  MunoRN} profile page
    0
    Maybe this is what you meant, but it's not the balloon that ruptures .03-0.2% of the time, it's the pulmonary artery that ruptures. (That's as often as 1/500, which is frequent enough to be of concern in such a severe complication)
  11. Visit  MunoRN} profile page
    0
    We have one cardiologist who will ask for infrequent wedge pressures, but other than that I don't see wedge pressures used anymore for clinical decision making. We usually still get a single wedge pressure on our OHS patients on return from the OR, although it means nothing. Clinical decision making on our open hearts is based on CO/CI, PAs/PAd, SBP/MAP, and SVR (as well as ABG's, labs, etc). We don't figure in wedge pressure or even CVP for that matter.

    I agree it's a skill that is being lost, which is always unfortunate, but at the same time if we aren't using the number then we shouldn't be obtaining.

    Recognizing a wedged waveform is obviously still extremely important and in my experience that skill is still well honed in those that utilize PA lines, though I could see this being an issue in units with less experienced staff.
  12. Visit  Chisca} profile page
    0
    Quote from MunoRN
    Maybe this is what you meant, but it's not the balloon that ruptures .03-0.2% of the time, it's the pulmonary artery that ruptures. (That's as often as 1/500, which is frequent enough to be of concern in such a severe complication)

    My bad.

    Our study suggested that the incidence of Swan-Ganz catheter-associated PA rupture is 0.031%...

    CHEST Journal | Article
  13. Visit  CVmursenary} profile page
    0
    Where i work, anesthesia does not even advance the PAC into a wedged position on insertion. Also you'd have to be pretty inattentive to not notice an accidental wedge; it looks nothing like a proper PA waveform.
  14. Visit  SummitRN} profile page
    0
    Quote from CVmursenary
    Where i work, anesthesia does not even advance the PAC into a wedged position on insertion. Also you'd have to be pretty inattentive to not notice an accidental wedge; it looks nothing like a proper PA waveform.
    And yet... it has happened either by a balloon left up or somehow the cath advanced to stuck-in-wedge.


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