Re: Questions about PA pressures

we do not wedge (often) at our hosptal do to one of our cabg pt's dying from pa rupture when wedging. Also a wedge doesnt really give you a bigger picture compared to the rest of your numbers

Re: Questions about PA pressures

Originally Posted by hypocaffeinemia

OR and ICU are different monsters, I'll concede. Most of the ICU swans are just number generator risk devices with little practical relevance.

I will contribute that this maybe because many nurses don't know the significance of the numbers that are produced.

Re: Questions about PA pressures

Originally Posted by Manurse715

I will contribute that this maybe because many nurses don't know the significance of the numbers that are produced.

I use the Swan numbers a lot... then again, we are a transplant center. I'd say about 50% of the nurses on my floor are good with Swans, the others are clueless.

Re: Questions about PA pressures

Originally Posted by RedCell

I don’t know dude, I would think about revising that statement. Just today I put a heart to sleep. Guy was 80+ years old getting a CABG, MVR and MAZE. Had a hx of a-fib, significant pulmonary htn and a preserved EF based on his echo. Couple of other expected comorbidities. A-line placed preinduction and hooked up to a vigileo. I thought that maybe the CO/CI and SVV numbers would be more useful being that the dude was rate controlled in the 70’s. That thing proved itself to be absolutely useless and inaccurate. . . .

The Vigileo is not accurate when a patient is in A-fib. Think about it. How could it be?

Re: Questions about PA pressures

I'm looking at Vigileo online right now. It says it is calibrated to account for vascular tone according to its algorithms. Many of our pt population have been smoking cigarettes and shooting up since they were 12. With a helping of uncontrolled DM and HTN. Are the algorithms taking co-mobidities into account?

Re: Questions about PA pressures

Originally Posted by classicaldreams

The Vigileo is not accurate when a patient is in A-fib. Think about it. How could it be?

SVV is also not accurate when the patient is anything less than completely ventilator-dependent.
Technology is a fickle mistress.....

Re: Questions about PA pressures

Originally Posted by aCRNAhopeful

I was wondering what you all thought about assessment of certain PA pressures. At my hosp, there is currently only one CT surgeon and this particular surgeon never asks or cares to know about the PAWP. I believe he uses the PAD to assess the LV function but I am not sure. I know that PAWP is a reflection of LV preload and if I'm remembering correctly should be about equal to the LVEDP. The nurses on my unit do not wedge at all for this reason so I guess what I am wondering is should I be assessing wedge pressures even though the doc doesn't use them? Also, is the PAD a reliable indicator of LV function? And what is the relationship of the PAD to the PAWP? I want to be knowledgeable about PA caths and hemodynamics in general as much as possible and I feel like wedge pressures are probably valuable information and need to be assessed but what good is it if I've never been taught how to do so. Thanks for your help!

The PAWP is just one number in your patient's hemodynamic profile. When looking at your patient's situation, consider all the parts of the puzzle, not just one piece. By this, I mean how does the PAWP compare to the CVP, PA pressures, blood pressure, and cardiac index/cardiac output? One number by itself is meaningless without considering the whole. As for the PAWP, it is nice to have, but not a detriment if you do not. Knowing that your PAWP cannot physiologically exceed your PAD (unless your patient is an alien and has some strange reverse flow of blood), you will always have a ball park idea of where you stand in terms of left ventricular function. So, to sum it up, high PAD usually equals high PAWP (lasix or inotrope time) and low PAD typically equals low PAD (need more volume captain!). Hope this helps.

Re: Questions about PA pressures

Originally Posted by hypocaffeinemia

OR and ICU are different monsters, I'll concede. Most of the ICU swans are just number generator risk devices with little practical relevance.

I have seen many more positive outcomes based on swan readings than negative outcomes from having a swan in place during my years in CVICU. So often we look at our PA pressures, CVP, and CI to let us know that a patient is in need of fluids despite an adequate blood pressure. I have also used it several times as an early indicator that a patient is starting to tamponade.