[AJACKSON1048]

Big debate at my icu unit. currently using ice water.. New doctor came and states we are to use room temp for the cardiac injectate and also not to disconnect the injection port from the system. I have took a stand with him because any place I have ever worked we used room temp. and when you disconnect you have caused a huge infection concern. Anyone agree or disagree?

[TopherSRN]

Your post is very confusing, but my suggestion is a CCO swan. Only time I've used non CCOs are from xfers. Used iced injectate and left it connected. Thankfully we don't even have setups where I'm at now.

[wtbcrna]

Originally Posted by AJACKSON1048

Big debate at my icu unit. currently using ice water.. New doctor came and states we are to use room temp for the cardiac injectate and also not to disconnect the injection port from the system. I have took a stand with him because any place I have ever worked we used room temp. and when you disconnect you have caused a huge infection concern. Anyone agree or disagree?

Unless you are using an old system for swan measurements it should be room temperature. I would also look up the manufacture's recommendations for your equipment.

Here is an abstract I found on Medscape.com.


Thermodilution measurement of cardiac output in patients with low output: room-temperature versus iced injectate.
CME
AMD Special Report CME Newsletter: Volume 3
Drs. Paul Sternberg and Franco Recchia evaluate possible changes in ophthalmic practice with anti-VEGF agents; Dr. Paul Latkany presents an unusual case; Dr. Robert Bernardino reviews the literature.

Medscape Newsletters

Am J Crit Care. 1998; 7(6):436-8 (ISSN: 1062-3264)
Kiely M; Byers LA; Greenwood R; Carroll E; Carroll D
Department of Nursing, Massachusetts General Hospital, Boston, USA.

BACKGROUND: Measurements of cardiac output with the thermodilution technique add to data for clinical decision making and therefore must be valid and reliable. However, the results of studies on the accuracy of values obtained with room-temperature and iced injectates, especially in patients with high or low cardiac output, have been conflicting. OBJECTIVE: To determine the effect of the temperature of the injectate (iced or room temperature) on cardiac output values obtained with the thermodilution technique in critically ill adults with known low cardiac output. METHODS: A convenience sample of 50 subjects (41 men and 9 women) who had a cardiac index of less than 2.5 (calculated as cardiac output in liters per minute divided by body surface area in square meters) before the study had cardiac output measured by using a closed system and manual injections of room-temperature and iced injectates. RESULTS: A paired t test indicated no significant difference between iced and room-temperature injectates for cardiac output (iced, 3.62 L/min; room temperature, 3.71 L/min; t = 0.99; P = .327) and cardiac index (iced, 1.95; room temperature, 1.99; t = 0.71; P = .482). CONCLUSION: The findings support the practice of using room-temperature injectate to measure cardiac output in patients with low cardiac output.

[HillaryC]

We used room temp injectate with our old monitors and currently use it with our new monitors. The computation constants in the monitor assume room temp injectate. I'm not sure what you mean by disconnecting -- we have a closed system where you pull the NS from a bag and inject it into the patient without any disconnecting/reconnecting. The syringe is clear purple plastic.

[pinoyNP]

Agree with post saying to check manufacturer's rec's. In our ICU, we use room temperature saline in both old and newer monitors. The nurses do not "disconnect" which I am having trouble trying to visualize how you can do that when it is a closed system.

[faithmd]

Oh my gosh, injecting for a CO...that's been a looooong time for me!

You don't have CCO swans?

[pinoyNP]

can you explain how CCO swan works?

[faithmd]

Originally Posted by pinoyNP

can you explain how CCO swan works?

Here is a couple of links:
http://www.edwards.com/products/paca...cocatheter.htm


this one is a video:
http://www.edwards.com/Products/PACa...s/Ccovideo.htm

[pinoyNP]

Very nice! We do utilize Edwards products particularly the combined continuous SvO2 and Swan-Ganz catheters. We still use thermodilution with injectate for CO/CI determinations. There is a plan to update the entire system in the near future. We may end up with something similar to the one you offered a link to.

[faithmd]

If you are going to look at purchasing new SG's, I don't know how much influence you have on decision making for purchasing, but the Baxter CCO Swan was (in the nurses and RT's opinion) the better swan. It lasted longer, and it didn't "crap" out when a patient was hypo or hyperthermic. I worked in a Trauma and Burn unit and when we redid things (some years back) like monitors and computerized charting, we went with Abbott CCO SG's because they promised to develop a module that would interface with our monitors and then allow downloads to our computers for vital signs. They did do that, but the Abbott SG's seemed to "die" in three to five days, if you were lucky to get that out of them. If your patient had a temp of greater than about 103F or less than about 97.3F, they were inaccurate and stopped providing CCO data. The Baxters never seemed to have problems. Also, the Baxter "balloons" seemed to hold up better. I don't have experience with any other brands, though. One last thought, we liked the Baxter drug calc software better, it was much easier to use than the Abbott.