Are swans going "out of style?"
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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
1Mar 19, '13 by chudderSwans are definitely on the way out. We only see them in hearts, and plenty of places are doing hearts without swans these days, too. The evidence for their use just isn't there.
I would LOVE to get my hands on one of these NICOM Cheetah bioreactance devices!
Most of the non-invasive options have one limitation or another. Esophageal doppler is great but not for conscious patients and it only looks at flow in the descending aorta. SVV, SPV etc is, AFAIK, only really validated in patients who are not breathing spontaneously.
Here is a fantastic review article on some current noninvasive monitoring techniques, written by Dr. Marik. His 2008 systematic review of the utility of CVP as a guide for fluid resuscitation is a very good read.
1Jul 23, '13 by ICUPrincessNurseEveryone of our hearts gets a swan and they all come out POD 1 unless we're having problems. We'll swan our MICU to look at fluid needs, LV function and PA pressures. Our SI patients RARELY get them unless they've just gone into total collapse and even then, it's basically never. I put a swan in a SI patient ONCE...and it wasn't so much an SI patient as it was a LifeGift patient and my options were "float a swan or go to cath lab". I chose to float a swan and stay on the unit with my not quite so stable donor. I wasn't sure my trauma guys actually knew how to float the thing!!!
For most patients, MI, SI, neuro we use a vigileo to look at CO or a presept catheter to look at ScVO2. But sometimes you just need a bigger, more complete picture...then the swan comes out to play.