[putmetosleep]

Originally Posted by Chisca

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.

Unfortunately, I have seen all of these things too (and I've only been practicing a few years!). When I first started in SICU as a new grad, I was told "we hardly ever wedge here, esp not open hearts, we never wedge open hearts". A few months down the road, one of the attendings asks me why I haven't obtained a wedge pressure--turns out we DO wedge after all. That prompted me to seek out more information on my own and not rely so much on my co-workers. I want to know the CORRECT way to do things, not the "usual" way. I have learned a ton while studying to take the CCRN exam, and I would urge anyone to do so. It's made me look at the things I do everyday in greater detail and TRULY understand it.

Actually, I shouldn't say that I do these things everyday, b/c I don't anymore. I was SICU for a few years then went to cardiology to "see what it's like" somewhere else. I've learned a lot, and it's opened my eyes to the realm of non-critical care, but I miss ICU so much! Going back soon, I think.....

[CVICURN2003]

Our hearts rarely come back with swans. Maybe one a week out of 16-18? Many times we have a "Double Stick" that we could float a swan into if needed, but we don't do that often at all (maybe once in my 6 years there). Sometimes we will put in one on a patient we brought up open that "won't make it make it an hour" when they were brought from the OR "to die"...because we all know they DO NOT DIE IN THE OR, and they live for several more days (then are on CRRT, all pf the wpnderful things we have to offer). I wish they came up with them more.

[Chisca]

"I want to know the CORRECT way to do things, not the "usual" way"

[TopherSRN]

Why do people want to wedge so badly? The PAD usually correlates and if it doesnt and they're that sick I get a LA line at my new gig. I guess thats the one advantage to the ivory tower.


I just don't understand the romanticism with wedging :/


PS: To stay on topic. The PP hosp i worked at used swans on 90% of their cases except softball cases where they didn't even bother placing epicardial wires. The academic hospital I'm now at uses them somewhat but often times they come back with LAs.

[Chisca]

Originally Posted by TopherSRN

Why do people want to wedge so badly? The PAD usually correlates and if it doesnt and they're that sick I get a LA line at my new gig. I guess thats the one advantage to the ivory tower.


I just don't understand the romanticism with wedging :/

Mitral regurg for 500 dollars, Alex.

[bellakt2]

I work in a pretty big ICU in Baltimore and I think I have seen one SWAN since I have worked here (over a year). Typically we use PICCO.

[putmetosleep]

Originally Posted by TopherSRN

Why do people want to wedge so badly? The PAD usually correlates and if it doesnt and they're that sick I get a LA line at my new gig. I guess thats the one advantage to the ivory tower.


I just don't understand the romanticism with wedging :/

The PAD correlates to the PAWP in a "normal" heart. There are many instances in which the PAD is not reflective of LVEDP, such as mitral regurg/stenosis and aortic stenosis, to name a few. With mitral stenosis, for example, the pressure in the left atrium is really high because it's working so hard to pump blood through the stenosed mitral valve into the left ventricle. So your PAD measurement will be much higher than what your actual LVEDP is, so really a wedge pressure is the only way to know exactly what's going on in the LV.

[RNnewgrad]

We have started using the Vigileo Machine and obtaining the same info as a swan (except for a wedge pressure). It works via a TLC on the distal port and/or A-Line and only if the pt is intubated. Pretty cool!

[TopherSRN]

Originally Posted by putmetosleep

The PAD correlates to the PAWP in a "normal" heart. There are many instances in which the PAD is not reflective of LVEDP, such as mitral regurg/stenosis and aortic stenosis, to name a few. With mitral stenosis, for example, the pressure in the left atrium is really high because it's working so hard to pump blood through the stenosed mitral valve into the left ventricle. So your PAD measurement will be much higher than what your actual LVEDP is, so really a wedge pressure is the only way to know exactly what's going on in the LV.

Originally Posted by Chisca

Mitral regurg for 500 dollars, Alex

Originally Posted by TopherSRN

the PAD usually correlates and if it doesnt and they're that sick I get a LA line at my new gig

Thank you both

Any other pearls of wisdom you wish to impart on me?


I've been doing open heart for years taking care of VADS, double valves, triple valves,robotic valves, thoracic aneurysms, AAA, CABGs with EFs in the teens, aortic roots, heart and heart + double lung xplants, you name it and have never wedged. Yes it has its place, but I don't lay awake at night crying because I can't wedge. A wedge won't tell me much I can't figure out other ways, though I am spoiled by the LAPs I see so often now.

[putmetosleep]

Originally Posted by TopherSRN

Thank you both

Any other pearls of wisdom you wish to impart on me?


I've been doing open heart for years taking care of VADS, double valves, triple valves,robotic valves, thoracic aneurysms, AAA, CABGs with EFs in the teens, aortic roots, heart and heart + double lung xplants, you name it and have never wedged. Yes it has its place, but I don't lay awake at night crying because I can't wedge. A wedge won't tell me much I can't figure out other ways, though I am spoiled by the LAPs I see so often now.

I meant no disrespect--and certainly I don't question your experience and/or knowledge. Just trying to help others understand, that's all, isn't that what this forum is intended for? Maybe you know all these things already, but I'm sure there are people reading this thread who didn't. My comment wasn't directed at you, I simply quoted you so that my post would be relevant and others would know what I'm referring to. And by no means do I claim to know it all, far from it! That's the reason I even visit this website is to learn from people. I've never shed a tear over a wedge pressure, either, and I sure hope there isn't anyone who has.