Swan-Ganz Catheter Monitoring

  1. I work in a 300 bed level two trauma center. The unit I work in is a 8bed coronary care unit. We are seeing fewer uses of the swan ganz cath for monitoring. Anyone else seeing this trend?
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  2. 8 Comments

  3. by   gwenith
    Definitely. There is a BIG arguemnt for and against in medical literature basically since the inception of the SG. Question always has been do the benefits outweigh the resluts? Followed closely by the question does it really change management or outcomes.

    The acutal cases where there is benefit with positive outcomes are becoming more and more limited. With the advances in technology we will see this fade and sink into the museum of medical management.
  4. by   zambezi
    We still use swans for all of our post op hearts, we usually take them out the day after the patient is extubated (we try to fast track most patients)...if the patient is intubated for an extended period and hemodynamically stable then the swan will come out...of course, it is patient dependent...
  5. by   JohnnyGage
    I actually just had a conversation with Tom Ahrens this morning about esophogeal dopplers for hemodynamic monitoring. They only cost about $100 and can be placed by an RN... if you can drop an NG tube, you can place the ED. Great thing is, you can get all of your necessary hemodynamic profile from it: CO/CI, fluid status and ejection fraction. Because it reads directly from the aorta outflow, it actually gives you a better picture of the left ventricle. Combine this with a triple-lumen hooked up to a continuous SvO2 monitor, and you'd have al the information you need.

    Anyone using these yet?
  6. by   NurseGirlKaren
    Hopefully it's smaller than the probe for a TEE?
  7. by   JohnnyGage
    Originally posted by NurseGirlKaren
    Hopefully it's smaller than the probe for a TEE?
    Yup... apparently it's the size of an NG tube, though slightly stiffer.
  8. by   nimbex
    Anyone seen the lithium based non invasive monitoring? We did a trial with it a year ago, and I forget the company name. basically inject a dose of lithium something, it lingers for 24 hrs, and through a monitoring device you can get all your numbers BUT SVO2.

    Our surgeons are older than the grim reaper, don't dare call for anything, unless you know the svo2.

    But to specifically answer, Our swans have decreased in the CCU due to overflow from the MICU and drug to door treatment with thrombolytics, plus, any ST elevation goes straight to the cath lab, no matter what time, you need the cardiothoracic there to PTCA, so they often go straight for open heart if needed, rather than waiting a day or two on the IABP, swanned.

    Disapointing to me because I LOVE knowing all the numbers and where my patient sits, titrating drips and so forth, but as everyone is seeing, they don't always improve your morbidity mortality rates and tend to increase LOS.
  9. by   Maximus
    PA catheters really are an excellent tool for monitoring the hemodynamic conditions of our patients. There are not too many problems with the actually technology, just the way people use the technology. There is a lot of inconsistency and lack of training in the way PA catheters are used. Not all of the numbers are useful in all patients but some can be very useful. For instance, what better method is there to determine oxygenation than to look at both the SaO2 and the SvO2? Say you have a SaO2 of 98% on a cardiomyopathy - your like - hey they must be oxygenating pretty well. But their CO is really in the pits and their oxygen delivery sucks. If you had a Swan you could see that their CI is 1.4 and their SVO2 is 28. How would you know this otherwise. Blood pressure? Not really.

    CI is a measurement based on blood flow and not pressure. Blood flow is where the future is, not pressures. Pressures don't really tell us much. The new esophageal doppler monitors are all based on flows, even the filling pressures are estimated based on blood flow and not pressures.

    If any of the measurements from a swan are of little value, I would say they are the filling presses. They vary with so many different heart conditions like valve problems and the waveforms are read very inconsistently by different staff and the pt is in different positions.

    Anyway, PA catheters are very useful tools if we just think how we can most appropriately use them. They will not become obsolete anytime soon. The new noninvasive techniques look promising but say you have a pt that had a esophagus/stomach surgery with a short neck. You can't do either of the new noninvasive hemodynamic monitoring techniques.

    I'll admit it. I love swans and I know that they have saved lives for me.
  10. by   helix
    This was a great thread for me to read! We are a nine bed CCU...and we see swans so rarely that when we get one, we all have to dig our notes out!! We take turns wedging so that we all can get practice! The only time we get them is when the patient is a AAA post-op, and then if you call them with a number you are concerned with, they don't care anyway!
    The ED sounds fabulous...will have to look into that one!

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