Are swans going "out of style?"

Specialties MICU

Published

Just heard from a coworker who returned from a conference that there are a bunch of new, really cool, much less invasive way to measure cardiac output and such, and that we are going to be swanning people less and less in the very near future. Anyone have any experience with any of these? Are you actually seeing fewer swans?

Specializes in Emergency, Trauma, Critical Care.

All our open hearts come back with swanz.....I would love to get on the updated technology bandwagon!

I have heard a lot of physician's beginning to think they are overkill though, because that occasional patient that has such crappy numbers, but otherwise doing fantastic. And it could just be what's their normal is different from what we have created as the standard normal. Not everyone fits in a box.

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I think it depends on the institution and the unit... I worked in an SICU where we got CV surg, trauma, general surg, etc. All of our hearts came back with swans and we occasionally had a bad trauma or an ARDS or sepsis get swanned. We were pretty comfortable with them. We had the vigileos, but didn't really use them much.

I just moved to a new state and am in an SICU, but we don't get CV surg patients. Our open AAA repairs come back swanned, but now much else. We actually just had a whole discussion about the fact that the docs will be swanning more patients because the nurses are becoming less comfortable managing swans and the docs (and nurses) don't know what to do with the data anymore. We use a LOT of Vigileos in my current unit.

A couple notes on the vigileos (the device that attaches to the art line)... The accuracy of the readings depend on having a good arterial line waveform. If your waveform is off... so is your data. Also, the last hospital I was at trialed the vigileos, while simultaneously using a swan, in order to compare CO/CI data. We found that the numbers were pretty different. This isn't to say this could be due to "user error", or differences in injection technique, or arterial line waveform quality... But we pretty much stopped using the vigileos and stuck with the swans.

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Specializes in CTICU.

We use tons of swans, CTICU. Can't use the non-invasive stuff due to many cardiac mechanical devices which mess with pulsatility.

By the way, I don't know that they are "going out of style" at all - it's more that some evidence showed no advantage in outcomes, and higher risk with SGC usage versus no use.

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Not where I work; every "heart" gets a swan. However, it is usually removed by post-op day 2. The CT surgeons tried the non-invasive devices but decided that they want continuous monitoring; the non-invasives that we tried did not do continuous very well.

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Specializes in Critical Care.
Just heard from a coworker who returned from a conference that there are a bunch of new, really cool, much less invasive way to measure cardiac output and such, and that we are going to be swanning people less and less in the very near future. Anyone have any experience with any of these? Are you actually seeing fewer swans?

PA caths began "going out of style" at least twelve years ago. Negatives far outweigh the positives with the exception of the application in a very few scenarios. For the immediate post-op cardiac patient, the complicated trauma patient---yes. Even then, get the damn catheter out as soon as possible to prevent the possibility of the many MANY complications related to PA caths.

For those who are enchanted with the things I'm sure the phasing out of this "technology" will be upsetting. For those who are not amused by the silliness it will be a welcome breath of fresh air.

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For those who are not amused by the silliness it will be a welcome breath of fresh air.

Isn't this the truth!

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Specializes in Adult Critical Care, Cardiothoracic Surgery.

I mostly recover open heart patients on my SICU and everyone has a Swan post-op. I'm sure that if Vigelo costs more, we won't see it in our hospital :)

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Specializes in Cardiovascular.

All of our open hearts come back with swans that we attach to a Vigilance monitor for continuous CI and we also have been using the Vigileo attached to the art line. The CI between the two can be dramatically different at times. In that case we usually rely on the Vigilance reading. For the Vigileo to be effective you must have perfect conditions: acceptable art wave form, regular rhythm with no ectopy, (can't use with IABP), and little or no spontaneous respirations! About the only thing we are using the Vigileo for right now is to measure stroke volume variance (SVV) to help assess volume requirements. We can have some real sick hearts so our swans can stay in for 3-4 days if needed. I still believe swans are valuable tools for measuring CI and assessing volume states.

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Specializes in MICU, neuro, orthotrauma.

Vigileo here in the MICU. In our SICU they use swans for open hearts and traumas, but they are pulled quickly.

I am interested in the completely non-invasive devices. Anyone have experience with those?

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Hi! We have only recently started to see the Vigileos/Vigilance machines (can anyone tell me the difference?). I work in a Burn Unit, so we don't see them as often as other ICUs, and we NEVER have swans. So I feel a little behind, but I am studying for my CCRN and trying to use what I am learning and put it together with what I am seeing. Other than SVV, (the higher, the drier, right?), it doesn't seem our docs pay much attention to anything else. And to be honest - they don't seem to pay much attention to that! (which gets really annoying as we have to document everything SV, SVV, CI/CO and a couple other numbers I can't remember.) So I guess other than the SVV, what is the Vigileo telling us that a Swan wouldn't? And other than there being no wedging, why do people like these so much? It just seems like everything I am learning for the CCRN is saying you need to know the numbers from the Swan.

HELP!!!!!

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My hospital uses the Vigileo fast trak hemodynamic monitoring system but I'd rather have a swan.

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Specializes in Emergency, ICU.

I haven't seen a swan in years. We use 2 non-invasive machines, flotrac and cheetah. I love the cheetah device because it is completely nurse driven and doesn't even require an arterial line. We are getting very good results, especially when deciding whether to fluid resuscitate or start pressors.

But, I don't work with any cardiac surgery pts. I know our cardio-thoracic SICU still uses swans.

Sent from my iPhone using allnurses.com

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