[Chisca]

Topher, can you cite an article or reference text that supports not measuring PAW because PAD usually approximates wedge? It's so easy why would you not want to measure it?

[meandragonbrett]

Here is a link to an abstract discussing PAWP and PADP relationships. Anybody have any other literature?

http://www.ncbi.nlm.nih.gov/pubmed/3395235

[nurselizk]

It's true that it's easy to measure, but there is always a risk of rupturing the PA. We rarely wedge.

[TopherSRN]

Originally Posted by Chisca

Topher, can you cite an article or reference text that supports not measuring PAW because PAD usually approximates wedge? It's so easy why would you not want to measure it?

I don't think it necessary for me to go browsing pubmed to 'prove' that PAd approximates PAWP in a NORMAL heart. That is common knowledge and I am far too busy. This text was handy so on pg. 211 of "Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 3rd Ed" by Gloria Obkouk Darovic it states:

"During systole, no correlation between pulmonary artery pressure and left atrial pressure exists because of the systolic thrust of blood from the right ventricle. PAd pressure, however, is normally 1 to 4 mm Hg higher than left atrial pressure because of the slight resistance to diastolic runoff imposed by the friction of flowing blood against the highly distensible pulmonary vascular walls."

I never said 'DONT EVER MEASURE PAWP BECAUSE PAD IS THE SAME'. Im saying PAWP is a reflection of LAP, it isnt even an exact measurement. And in a cardiopulmonary system with near normal physiology PAd closely correlates.

Yes I know when stenotic or regurgitant valves are involved it won't.

Hell I could probably find 10 articles citing that PACs increase morbiity and mortality and should be used sparingly.


Nice abstract, you bother to notice it was from 1988?

[Chisca]

Can you tell me where I can find patients with a "cardiopulmonary system with near normal physiology"? I deal with uncontrolled hypertensives, septic patients not responding to fluid challenges, and liver transplant patients. If I relied on your assumptions about hemodynamics I would miss quite a few PAD/ wedge mismatchs.

Some of the comments posted in this thread simply reinforce what the AACN pointed out along time ago, there is alot of nursing ignorance associated with PA catheters.

"During the past 12 years, at least 6 studies or evaluations5-10 of critical care nurses’ knowledge of PA pressure monitoring have been done; mean test scores ranged from 31% to 65%. The lack of knowledge indicated by these studies is of concern because PA catheterization is one of the most commonly performed diagnostic and monitoring procedures in critical care.

Numerous research-based guidelines for PA pressure monitoring are available.47,54,55,123 Despite the availability of this large body of literature related to PA pressure monitoring, critical care nurses continue to demonstrate insufficient knowledge and ability to apply information related to the collection and interpretation of data obtained with a PA catheter."


My point is that maybe some of the decline in the use of PA catheters is directly related to lack of nursing expertise with them.

http://www.aacn.org/aacn/jrnlccn.nsf...4?OpenDocument

[Chisca]

Originally Posted by TopherSRN

I never said 'DONT EVER MEASURE PAWP BECAUSE PAD IS THE SAME'.

Yes, you did imply that.

Originally Posted by TopherSRN

Why do people want to wedge so badly? The PAD usually correlates

[TopherSRN]

Originally Posted by Chisca

Yes, you did imply that.

The decline of PACs probably has more to do with MDs than RNs.

[JohnW]

All of our hearts come out with Swans. We do not wedge, we use PADs.

We seldom Swan our non-CT patients, surgical patients. When we do it's most often a septic paitient whose heart is failing.

We are just starting to see the "Presept" triple lumens CLs that measure continouse SVO2 and can give CO/CIs, with these I expect to see even less swans.

[Chisca]

Originally Posted by TopherSRN

Hell I could probably find 10 articles citing that PACs increase morbiity and mortality and should be used sparingly.

Another example of myths about PA catheters.

"The meta analysis of 13 randomized clinical trials found no difference in mortality or length of stay between groups of patients who were randomized to PA catheter verses no PA catheter groups."

AACN Vol 17 #3 pp 286-305 2006

Shah MR, Hasselblad V, et al. Impact of the PA catheter in critically ill patients. JAMA 2005; 294 (13): 1664-1670

[sharrie]

Thread Closed for staff review