advandced monitoring in the ER

[phiposurde]

I was wondering how many of your ED have advanced monitoring in there department( art line, cvp, intra abdominal monitoring, ect)? Did you find that it delay the transfert your patient to ICU because you have such monitoring? Been part ICU part ER, yes a traitor in your list ,i'm trying to get my educator to get on board with the 21st century. Especially that me are one of the most acute trauma center, according to the news paper, in Canada. But the keep telling me the same: our RN are not trained, it will delay patient transfert, ect. They don't seem to undersatnd that the pt stay anyway and that we are throwing fluid like crazy and people withour knowing the cvp and just taking bloop BP. Thank you!

[mamalle]

Nope and our manager will not put them in- she feels that it will open more worms then anything and delay transfers to ICU and promote more holding.

[traumaRUs, MSN, APRN]

Few to no ERs in the US have CVP lines. Reasons:

1. Take trained personnel to put in and time and assistive personnel. Few ERs have extra hands.

2. Pts should NOT be moved once invasive monitoring lines placed unless absolutely necessary.

3. Should be done as sterilely as possible - not always possible in the ER.

4. If you don't use it, you lose it. Requires continuous competency. I worked in a level one trauama center (65,000 visits/year) and I can count on one hand we would have used CVP monitoring and that was in 10 years.

[nuangel1, BSN, RN]

nope not in any er i have been in .and shouldn't be thats what icu's are 4

[EDValerieRN, ASN, RN]

We are expected to do CVP monitoring on all of our septic patients in the ED. Our attending MD's put them in, and we're currently undergoing training to be able to adequately monitor CVP.

I don't feel like it delays transport of patients. Our ICU's are good about making room if there is none, they make it a priority. I do, however, believe that if a patient truly needs this monitoring and the ED isn't providing it for fear of prolonging transport, the ED will be in a lot of trouble when someone dies from something that could have been prevented.

We also do art lines on the daily... respiratory puts them in, and we monitor them. Is that not something ER's do? I wouldn't feel too comfortable with a manual cuff and a tanking blood pressure that needs pressors....

[neneRN, BSN, RN]

Like Valerie, we monitor CVPs on our septic patients. Do art lines as well.

[Lurksalot, BSN, RN]

Yes, we do the septic protocol with CVP and SVO2 monitoring via precept catheters. We have several critical care rooms in our ED and our residents insert the catheters once septic protocol is initiated. We must take an extensive critical care course and have training on setting up and monitoring the equipment. For those of us in our ED who are comfortable with the protocol and equipment, it's pretty routine, and we do see many, many septic patients. We hold them until the ICU bed is available. I like using the equipment and am comfortable monitoring it the best we can in the ED, and it is much better for the patient to be able to see what the CVP is doing and adjust fluid boluses according to the response. We also do a lot of a-lines on patients going to the unit, and I've had a patient get a ventriculostomy for a massive bleed.

Of course, all that said, I HATE taking the patient up. Us ED folks are so messy with all the lines, and our patients do not usually look too "pretty" when we take them up! Our equipment is all portable and it is a big mess when we drag it all up. We get done what needs done, but it is the ICU RNs who have the talent for keeping things very organized and more efficient!

[RedERRN]

In my ER these things are not optional...they are mandatory. We spend 90% of the time with no available adult ICU beds...NONE. Our ER becomes the ICU overflow area. If a patient needs CVP monitoring, we do it. Central lines are inserted by the surgery residents. A-lines are commonplace for the Level I area of our ER and all those rooms are stocked with A-line setups.

There are a few things that we do not do:

most enemas

epidurals

PCA pumps

[BULLYDAWGRN, RN]

We have the capabilities to monitor everything from art-lines to swanz in the er with new monitors that we have. But I can only recall them only putting in a full swanz only a few times over the last few yrs, but they'll put a art line and drop a central line and hook up a cvp in a heartbeat. Matter of fact the last shift I pulled in the er we hooked a cvp on a burn pt.

[mamalle]

trauma room is different- we have two monitored beds in there so that is a different story. they only thing we do is on occasion put a ventriculostomy in and try and get them to ICU asap.

[gonzo1, ASN, RN]

50,000 visits per year. No art lines, no cvp, once in a blue moon a cvc line. Don't know why we don't do any of these but we are only level 2 and have no residents that need the practice. Our ICU is great and usually has a bed. Thank God

[TopherSRN]

1. Take trained personnel to put in and time and assistive personnel. Few ERs have extra hands..

Last I checked ER Attendings can put in CVLs as can residents and interns.. It takes a tech to hold the saline flush or not depending on how creative the physician is.

2. Pts should NOT be moved once invasive monitoring lines placed unless absolutely necessary..

Wha? People with CVLs goto CT all the time. A CVL isn't a contraindication to moving. People walk around on the floor with CVLs.

3. Should be done as sterilely as possible - not always possible in the ER..

Not hard to drape for an IJ or SC CVL. Were not setting up a room for a CABG/AAA, its just a CVL. A competant attending can have it in and flushed within 5 mins.

If I worked ER id be opposed to Alines/CVPs/PA caths too. These are things that should be done in the ICU and doing these in the ER would only encourage boarding of these patients. If someone needs an aline/PA cath they should get it in the OR or the unit.