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!

Re: Questions about PA pressures

People don't do wedges a lot anymore because
1. There's a chance of PA perforation/rupture or balloon entrapment
2. There's no evidence that using PCWP to guide therapy has a positive impact on patient outcomes over any other less invasive parameter.

What's the point of measuring it if noone is going to interpret it?? Especially with the risks v benefits? I'm a cardiac nurse and I love my numbers, but I have had to bow to the evidence on this one. In fact there is little evidence that using SGCs in post cardiac patients improves outcomes, which is hard to believe.

PAD is "good enough" to estimate LAP, which is a good indicator of worsening HF. You really just want to see: is the LV pumping? is there fluid overload? how much? LAP is a good surrogate for LV function as long as you have a competent MV.

I would suggest further reading - there's a lot of articles about invasive hemodynamic monitoring. You're smart to learn it well - it's one of the most used and valuable pieces of knowledge in critical care.

Here's a PPT I see online: Hemodynamic Monitoring

Re: Questions about PA pressures

The fact that swans are used at all anymore when adequate NICOMs exist is an affront to logic.

Re: Questions about PA pressures

Well, NICOMs have a lot of asterisks to their reported accuracies. Depends on your patient population.

Re: Questions about PA pressures

The Pulmonary Artery Catheter Education Project is available on line.

There is a free registration to access site.

Re: Questions about PA pressures

Re: Questions about PA pressures

Thanks alot. I have began to go through the pacep.org lessons which are great but just haven't had enough time to complete them. I will definately adding this info to my knowledge base soon. I think this stuff is fascinating

Re: Questions about PA pressures

May want to consider picking up Kathy White's fast facts for adult critical care..she's got a great section on hemodynamics I use as a reference for mentoring.

Re: Questions about PA pressures

Originally Posted by hypocaffeinemia

The fact that swans are used at all anymore when adequate NICOMs exist is an affront to logic.

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. TEE completed by anesthesiologist confirmed vigileo inaccuracy. I put in a PA catheter after induction and got more reliable numbers. Used it to guide pharmacologic and fluid replacement throughout the case. Especially coming off bypass. I don’t care what any evidenced based study shows. This gomer benefited from a swan and that is definitely not an ‘affront to logic’.

Re: Questions about PA pressures

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