[meandragonbrett]

We use swans all the time.

[tifftaff81]

We use them mostly in CCU and ICU here. They prefer them not to be in our MICU, primarily because it is somewhat a detached unit, location wise, from our main unit. They are on all our fresh open hearts as well as patients who are severely critically and the MD drops them in at the bedside. That is rather seldom though, and usually used if a patient is declining rapidly.

[nursejill155]

It seems that most people on here have stated that they don't see swans very often and I have to say that I see them quite a bit! All of our post-op hearts/valves have them, septic pts usually have one, some patients have them after major abd surgeries to manage fluid resusitation properly also traumas have them. I don't really understand why they are not being used lately by so many, how else do you have a good picture of the patient say who is septic? or a post-op of a huge surgery? I would say, study it, it is always good to know! I hope that helps some!

[Christie RN2006]

All of the open-heart patients in our CVICU have them post-op. We don't see them very often in the SICU or CCU though. We mostly see CVP and A-lines, but not swans anymore. I'm not sure exactly why the docs have been shying away from using swan lines, I have heard its because there really isn't much of a difference in mortality rate between those who did and those who didn't have one.

[meandragonbrett]

Originally Posted by Christie RN2006

I'm not sure exactly why the docs have been shying away from using swan lines, I have heard its because there really isn't much of a difference in mortality rate between those who did and those who didn't have one.

You're right, a study showed that swan vs. no-swan had practically no difference in morbidity & mortality. Swans seem to come and go. They'll be the in thing for a few years and then die down for a few and then make a come back. I think that typically you will see the majority of swans in CVICU/CTICUs and Trauma ICUs

[Chisca]

But how much is physician reluctance to use a pulmonary artery catheter because of the perception the nursing staff can't manage it? Does anyone know how to graph a waveform and find end expiration point? Find the A wave and the V wave? Know what to do when a catheter becomes stuck in wedge? I'm sorry, but I find this as more evidence of the dumbing down of nursing and structuring knowledge to the lowest common denominator.

[putmetosleep]

Originally Posted by Chisca

But how much is physician reluctance to use a pulmonary artery catheter because of the perception the nursing staff can't manage it? Does anyone know how to graph a waveform and find end expiration point? Find the A wave and the V wave? Know what to do when a catheter becomes stuck in wedge? I'm sorry, but I find this as more evidence of the dumbing down of nursing and structuring knowledge to the lowest common denominator.

I'm not too sure what to make of this post...are you venting about the physicians' perception of nursing knowledge, or actual nursing knowledge?
I DO know how to graph a waveform and find the end-expiration point (peak=patient, vent=valley). All measurements should be taken at end- expiration. The A and V waves are present on PAWP waveforms; in comparison to the EKG strip, the A wave comes right after the QRS complex and the V wave comes right after the T wave. It' important to know this because the only way to measure anaccurate PAWP is to take the mean of the A waves. Taking the mean of all the waves (A, V and C) can give you an extremely inaccurate PAWP measurement depending on the waveform.
Sufficient?

[Chisca]

Originally Posted by putmetosleep

I'm not too sure what to make of this post...are you venting about the physicians' perception of nursing knowledge, or actual nursing knowledge?
I DO know how to graph a waveform and find the end-expiration point (peak=patient, vent=valley). All measurements should be taken at end- expiration. The A and V waves are present on PAWP waveforms; in comparison to the EKG strip, the A wave comes right after the QRS complex and the V wave comes right after the T wave. It' important to know this because the only way to measure anaccurate PAWP is to take the mean of the A waves. Taking the mean of all the waves (A, V and C) can give you an extremely inaccurate PAWP measurement depending on the waveform.
Sufficient?

Maybe I've been in Memphis too long. I have only encountered one other nurse here that knew these things and she was from Canada.

[putmetosleep]

Originally Posted by Chisca

Maybe I've been in Memphis too long. I have only encountered one other nurse here that knew these things and she was from Canada.

Didn't mean to sound rude, but come on, you've gotta put some faith in your fellow CC nurses! If you work with nurses who don't know this stuff, then please, educate them. Maybe they won't like it at first, but it will improve their practice tremendously--not to mention make them seem more credible to the docs. Where are you from originally? Sounds like you haven't been in Memphis forever...

[Chisca]

Originally Posted by putmetosleep

Didn't mean to sound rude, but come on, you've gotta put some faith in your fellow CC nurses! If you work with nurses who don't know this stuff, then please, educate them. Maybe they won't like it at first, but it will improve their practice tremendously--not to mention make them seem more credible to the docs. Where are you from originally? Sounds like you haven't been in Memphis forever...

Minnesota, California, then here for the past 20 years. I have worked in nearly every hospital in this city that cares for adults and belong to the local AACN chapter. I have tried to stay at hospitals that were associated with the University of TN and it's medical training program because teaching hospitals seem to give nurses more respect. I'm all for education because I do enjoy this profession but if I had a dollar for every time I was told by staff "we don't wedge here" I could retire. When I ask why I'm told because Dr So and So doesn't want us too. Ask Dr So and So and it's what medical school did you go to? And if they do obtain a wedge pressure it is by pressing a button on the monitor, pushing on a syringe, and charting the number displayed. I have even seen negative PA pressures charted.