Are swans going "out of style?" - page 3
by TemperStripe 8,159 Views | 32 Comments
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... Read More
- 1Feb 18, '13 by JemJHi! 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.
- 1Feb 18, '13 by edmiaI 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.
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- 2Feb 19, '13 by IABP4UI'd say, yes, swans have gone out of style. However, you'd probably find the majority of them used in management of patients after cardiac surgery. What always amuses me is the number of times I have called a surgeon about bad hemodynamics only to get a response like, "I don't care. Why are you calling me about that?" Alot of research has shown questionable patient outcomes with having a swan vs not having a swan. In my personal experience, I'm convinced that there are many doctors/nurses who misinterpret the numbers obtained from a swan. So is the issue the actual piece of plastic sitting in the pulmonary artery or the provider making poor decisions based off the numbers? Food for thought....
- 1Feb 20, '13 by armyicurnWe just started with flowtrac and I really like it. Real time readings. Less messing around with a PA cath and pushing injectate to get CO numbers. On top of all this, I do not get paid enough and I have a lot of charting to do. It is time to put less invasive lines in people!
- 1Mar 14, '13 by murphyleI'm in a cardiovascular surgical ICU, so every post-op heart comes back with a Swan. We have rather a love/hate relationship with them; they're great for accurate hemodynamics, but as long as the Swan stays in, the patient has to stay in bed, which makes us look bad on early mobility goal measures. Hence, we're seeing a few of our docs and midlevels start pushing for Vigileo FloTrac on patients whom they want mobilized but still want hemodynamic monitoring. Therein lies the rub.
My issue with FloTrac, and by extension most of the minimally invasive devices (whether they run off a radial A-line or a bioimpedance method) has to do with the accuracy of the system under one of the reps' biggest selling points - namely that such systems claim to provide hemodynamic profiling that doesn't require the patient to be vented and bedbound. For an intubated, vented, bedbound patient on a pile of drips (i.e. your average MICU player), Swan and FloTrac are probably going to come up with pretty similar numbers, and FloTrac might well be the better choice. However, once your patent is extubated and starting to get mobile, the FloTrac becomes less and less reliable, to the point where it eventually starts giving you voodoo numbers. If you have a patient who still needs hemodynamic profiling at that point (worried about low CO/CI r/t hx systolic failure or hx cardiogenic shock, need to titrate inotropes, whatever), the machine starts turning from a friend into a frenemy. FloTrac's accuracy also suffers if your patient is arrhythmic for whatever reason (A-fib, higher order AV blocks, other sinus and supraventricular arrhythmias, etc). As a result, I've seen nurses, midlevels and physicians all trying to manage patients - and erring badly - as a result of inaccurate FloTrac data.
In a case of serendipity, I had an extensive discussion with our local Edwards Lifesciences rep yesterday about just this issue. According to her, there's a next generation system coming out Real Soon Now that aims to address all those issues and more. Personally, I won't be holding my breath.