To run infusion with CVP or not... That tis the question..

[kmarieCCRN]

So, this past week some coworkers of mine had gotten into a heated debate as to whether or not it's okay to run an infusion of something other than NS (3%, sedation, etc.) with your CVP line if you've run out of access. One of the arguments was that you could possibly bolus your patient with whatever gtt you were running with the CVP line.

What do you guys think? Do you ever run fluids/gtts with your CVP? Do you have policy on this?

[offlabel]

While CCO has advantages I don't think you can really say that overall it's better than bolus thermodilution. The biggest problem is that people falsely assume it's in real time, even though the CI that appears on the screen is actually the CI from 5 to 15 minutes ago. And while there are some studies that suggest comparable accuracy, the overall body of evidence finds CCO to be less accurate than bolus thermodilution, which is why there are manufacturers that incorporate the ability to shoot "old school" CI's with their CCO catheters. It would just based on how they work that bolus thermodilution would be more accurate since pulsed heat CCO catheters are producing a small blood temperature change at the RA which is then makes for a much small curve to measure in the PA, generally smaller things are harder to measure accurately.

Our Edwards device gives CO's every 2 minutes which, for cardiac output, is for all practical purposes real time. But that is way overkill in any other setting besides the CVOR and immediate post op hearts. And we don't use them nearly as often as we use to. As to the accuracy, even assuming the old catheters are, in perfect conditions more accurate, the difference in numbers are not clinically significant, ie, it's not enough of a difference to change the therapy, especially given the variability between different operators of the injectate catheters.

I still say, all things, including cost (which it isn't) being equal, I'd choose the CCO for what I do for a living. Very sick hearts and lungs benefit from having the continuous SvO2 as well.

Your results may vary.

[tcvnurse, BSN, RN]

Yes, some pretty famous big name teaching hospitals still do thermodilution cardiac outputs.

Ha ha ha yeah I work at one. Didn't know tip someone came from Mayo to our place that it was done any different.

[Ruby Vee, BSN]

Our Edwards device gives CO's every 2 minutes which, for cardiac output, is for all practical purposes real time. But that is way overkill in any other setting besides the CVOR and immediate post op hearts. And we don't use them nearly as often as we use to. As to the accuracy, even assuming the old catheters are, in perfect conditions more accurate, the difference in numbers are not clinically significant, ie, it's not enough of a difference to change the therapy, especially given the variability between different operators of the injectate catheters.

I still say, all things, including cost (which it isn't) being equal, I'd choose the CCO for what I do for a living. Very sick hearts and lungs benefit from having the continuous SvO2 as well.

Your results may vary.

You can prefer whichever system you like, but you have to work with the system provided by your facility.

[offlabel]

You can prefer whichever system you like, but you have to work with the system provided by your facility.

We have both.

[Ruby Vee, BSN]

We have both.

Then you are indeed fortunate. Are there any policies to address who gets which system?

[offlabel]

Then you are indeed fortunate. Are there any policies to address who gets which system?

Not a matter of policy, it is what the objectives are for the particular patient. If a PA pressure is all that is needed to asses cardiac function, the CCO catheter is way overkill, so we use the standard Swan.