[HLopez]

Recently, I was teaching a class in PA caths with basic hemodynamics to the ER staff. I have VERY mixed feelings about the teaching of this class. The nurses that attended understood the lecture but I know it will not stick for long. My question is....Is this a waste of Education, on my part, or will this really be usefull? I want to hear from places that are actually using this in the E.R.. The Doctors are really pushing this to be done. However, with three more patients to take care of, is this a good practice?? Hummm I Dunno.

[suzanne4]

I have used Swans for a very long time but never in the ER setting. If the patients are that critical, they are going to be going either fairly quickly to the OR or ICU. Unless you are using them all of the time, the nurse is going to be nervous in shooting a cardiac output and everything else about them.
Having problems with a catheter that is wedged, etc.

Just my $0.02..............

[Dixielee]

I agree the ER is not the place for SG catheters. I too have worked with them and see very little value for them in the ER setting. A quick CVP would give you roughly the same info in a pinch. With the PA cathethers you are looking for trends as well and you don't have time to monitor trends in the ER. As above, these folks need to go to the OR or ICU if they are that critical and if they are that critical you don't need a PA catheter to tell you that! What happened to good old assessment skills? Unless it is a teaching institution where there are interns and residents just chomping at the bit to insert lines, I don't think most ER docs would be comfortable with it and the follow up that is required. Get that patient stabalized and ship them out of the ER!!

[angel337]

swans would not be a good idea where i work because we are already a very busy hospital and we have ICU holds all the time in ED because of lack of beds or nursing staff in the ICU. the unfair part about this is that they expect us to take care of that one on one crtically ill patient AND have 2 other ED patients which i feel is unsafe. i think your inservice was helpful, they always are, but if a person is going to need a swan they should be taken care of by nursing staff that manage swans on a daily basis. i plan to cross train to ICU soon so i look forward to learning anything i can about that environment.

[traumaRUs]

As an ER nurse I would like the education but we wouldn't use them in the ER where I work. Also - we do use the noninvasive CVP machine so when we were inserviced we were told this was as good as it gets in the ED>)

[teeituptom]

Its only the ED MDs that want swans in the ER, they get taught how to place them in school and then go out to a real ER, They get bored with all the routine stuff and decide they want swans to put in, then they decide they want to keep the patient in the ER for a few hours so they can see how their drug interventions work. In other words they just wanna play with them.

[IamRN]

The use of the non invasive monitors (Bio Z) would be more appropriate in the ER...where there is room for their legitimate use.

[ERHack]

if they need a SG, they need an ICU bed...so get em on up there. Thats pretty much our ED philosophy.

[CCURN]

If they are sick enough to need a swan or a TL, then they probably should be in the ICU, distended JVD and crackles should probably be enough to warrant some lasix.........The ER staff are just too busy to get involved with a swan. :hatparty:

[stevierae]

I agree with everyone that Swans would not be needed in an ER--the whole point of a Swan is to be able to do cardiac outputs and wedge pressures; if a patient is THAT sick, he is either on his way to the OR or on his way to the ICU. They can be placed there under fluoro or even a post-op chest X-ray obtained to make sure position is coprrect, and, better yet, they can be placed by anesthesia providers or intensivists who place them ALL THE TIME--not by ER docs who might want to "practice" or "learn" how to put in a PA line.

The newer, portable, non-invasive monitor is a better choice for an ER setting.