PAWP readings

Dawn,

In the CCU I work in we only do it once a shift(when we do cardiac output) unless:
1. There is an order specifying how often the MD wants it done
2. A change in the patient's condition warrents that it be checked ie, if you think they are going into pulmonary edema

It is usually left up to us though. I personally don't wedge anymore than I have to for the exact reasons you mentioned above.

Hope that helps some!

A pulmonary artery occlusive pressure (wedge) is best done after any therapeutic intervention to determine its effectiveness. Also the lifespan of the balloon is only 72 wedges. The paop should be compared to the pad and determine if they are correlating. A pad may be used to determine the paop. All paop should be read from the end expiration. A patient that is not vented should be read at peak, and a vented patient at valley. (P-peak (patient) and V-valley (vent).

A PA line can be a very handy determinate of patient therapy--but only if read right.

Good luck with determining a policy. A PAOP should be read with interventions. On our unit, with tailored therapy for our cardiomyopathy patients, these measurements provide a guide for medications. That is exactly how all PA pressures should be done!

If zeroed when inserted, the PA diastolic is the same as the wedge. CVP readings give you volume status.

When in doubt, set priorities. What information do you need. Never forget, the best policy is to go by the hospital policy.


MicheleRN
Critical Care
Columbus, Ohio

At the CCU I work in, we rarely keep Swans in place for more than a few days and we check PAWP q4 hours. I also work in a CCU that are acuity of patients is the sickest of the sick. The only people other than acute problems are our Cardiomyopathy pts, who have them while in the unit waiting on a Heart and their meds are based on the pressures. Most of our docs want an actual wedge pressure, not the PA diastolic, only if their is a question of it validity can we use the PA diastolic and then usually they insert a new Swan-Ganz catheter if it is vital to the pts care.

I work in a post open heart unit and we do wedge pressures and cvp readings q2 hrs and prn when indicated, and manual cardiac output readings q4 hrs and prn, but the swans are usually d/c'd 1-2 days post-op.Some docs do use the cco swans, which are great when they work correctly!

In our CVICU, all of our OHS patients have swans. One of our surgeons only wedges in the OR for placement, and then asks the RN's not to wedge on a routine basis, especially for the valve patients. He thinks the risks outweigh the benefits, and we use the pa diastolic pressure for cardiac profiles. With the other surgeons, we wedge on arrival from the OR, and q4hrs after that. We wedge more often if we are titrating gtts, or if he calls for a reading.

I'm new to the CCU where I work and our hospital policy is to wedge q 1 hr on fresh hearts and if meds are titrated or new cardiac meds are added then go to q 2 hrs. and prn.

...I think I submitted twice... Sorry!