Swan-Ganz Use

Specialties CCU

Published

I'm a brand new nurse and the hospital I did my clinicals in did not use these. I don't want to say they NEVER did, but the general consensus at that hospital was that current research does not support their use, therefore they were pretty much phased out (we didn't even keep the supplies for them in our equipment room). However the hospital I am at now uses them all the time, and many of the nurses are not happy about how often one of the docs here will just put them in everybody (including non-cardiac patients). So my question is how often (if ever) are they used at your facility and what sort guidelines are in place for their use? The docs at my old hospital seemed to do just fine without them, so it confuses me why the doc here is so into using them with all of the risks they pose. Also, in your personal opinions (especially those of you have been nurses for a long time and greater amount of experience using them) do you think that the benefits outweigh the risks??

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What types of patients are you seeing them used in? We inserted a lot in a unit I used to work in to assist with patient management in sepsis as the pulmonary and surgery teams didn't drink the koolaid with the flotrac and precept caths.

A good rule of thumb with numbers, diagnostics, etc. is "IS the result going to change my management of this patient?"

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I guess that's my question about them. Anytime I've mentioned that my old facility did not use them, everyone would ask well how did you get CO/CI? So then I ask well what are we using those numbers to do? How much does it impact the course of therapy?? I honestly have no clue, because I have so little experience with them. As far as the types of patients, other than CABG, its been so variable that I can't recall off the top of my head, but I will start paying more attention to that. How do you incorporate those numbers into your nursing care?? So far in my limited experience I haven't used them for anything, bc honestly I don't know how to, but if I'm missing something I definitely would like to know :-)

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How do you incorporate those numbers into your nursing care??

Some drugs are titrated based off of your hemodynamic measurements.

Numbers you can get from a Swan include: PAS/PAD, CVP, CO, CI, EDV/I, PVR/I, SVR/I, EF, SV/I, and SVO2.

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I see... I haven't had orders to do that yet, so I guess I will get a better grasp of it when it happens.... I guess I'm just having trouble coming around to them since I've been groomed during my education/school clinical experience to believe that PA catheters are the devil and now working at a place where they are king lol

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I guess I'm just having trouble coming around to them since I've been groomed during my education/school clinical experience to believe that PA catheters are the devil and now working at a place where they are king lol

Take about 7/8ths of what you were told by your nursing professors and throw it out the window. It's time to learn how it's really done. There are docs/PA/NPs that will always be ones willing to put a swan in a dead person and other providers who wouldn't even think of placing one. It really just comes down to provider preference, familiarity with the numbers, and their views on using other non-invasive methods of measurement.

A swan can be very particular sometimes and can often give inaccurate numbers when you don't know what you're doing with it, if it's placed in the wrong zone, etc.

You could check out http://www.pacep.org for more education on the PA Cath.

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Haha yes I do realize that "happy nursing school hospital" does not = real world hospital... my preceptors are often amused by the things we were told in school lol... However, this was a hospital-wide view, not just that of my nursing professors.... And thanks for the website I'll definitely check that out... practiced shooting some COs today and do see how it can be particular. Had to do it a few times before my numbers were close to what everyone else was getting, but I'm going to work on getting it down... Thanks again for all the help :-)

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Specializes in Critical Care.

It's truly based upon what the patient's dx is. I work with open heart patients so we see a ton of swans. As another poster said, they are also used a great deal with septic patients. I laugh when I've worked at some facilities where nurses state that "no one uses swan's anymore"...usually this is said at a facility where the sickest patients are life flighted out or they do no cardiac surgery. It's truly amazing how each facility things their way to practice is the ONLY way!

I do have a problem with docs who put swans in then don't use the information they provided to direct care. That drives me nuts. If I'm allowed to tailor care on the information provided, I'm a huge proponent!I love swans, they can tell so much.

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Specializes in ICU.

I worked for 8 years in an ICU where swans were used every day. Just about all of the pulmonologists and cardiologists used them. We used to say it must be a real money-maker for the docs! Oh, you have a heplock and 02 at 2 lpm?? You need a swan! Now I work in an ICU that NEVER uses them. Go figure.

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Specializes in Trauma/Tele/Surgery/SICU.

You could check out http://www.pacep.org for more education on the PA Cath.

Not to hijack this thread but I was struggling with these concepts and this link has really helped me get a better overall understanding and I really appreciate you posting it!

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Is the PA catheter used by Habit Based Medicine or Evidence Based?

Because we've always done it like this no longer holds up in Evidence Based Practice.

http://anestit.unipa.it/mirror/asa2/practice/pulm/pulm_artery.html

Any invasive procedure will now face scutiny and CMS will be taken seriously. These procedures are also no longer the cash cows they once were for physicians. We used to have docs stumbling over themselves for procedures.

We used to put in an Arterial Line into every ventilator patient and now we rarely do an ABG unless there are multiple conditions that exist which warrant one.

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Specializes in CTICU.

How can I explain this to you in simple terms? Let's see. I like to call the pa cath, ''GOD''. If you are proficient using it, it will safe a patients life due to your interventions using the numbers from the pa line. For example, a CABG patient with a Blood pressure of 70/40 and no pa cath. Can delayed tx of the real issue cause you can only assume of many things that can be going wrong with the patient. Now if you had a pan cath. You can easily tell if its a hemorrhagic event or maybe just a vasodilatory effect or weak inotropy of the heart. In conclusion, it should be use with the sickest patients to increase survival. By the time you would see s/s of distress in a sick patients by using a regular physical assessment then it would be to late for the septic patient without a pa cath.

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