does anyone use swans anymore?

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Call me crazy, but I have decided to retest rather than get ceu's to re-up my ccrn certification. I did ceu's the first time I renewed, but feel like studying and retesting will give me the knowledge that I want. I'm nervous about hemos however as we rarely use swans anymore. Not using that information daily has lead to me losing everything I once knew...normal values, calculations etc. A big part of the test did require use of this information to get the right answer. My question is, do other hospitals still use swans alot? How can I prepare for this portion of the test? Back when I originally tested every other patient in our unit had a swan...now, maybe one every 4 months or so. Any advice?

Specializes in SICU/Trauma.

It seems that most people on here have stated that they don't see swans very often and I have to say that I see them quite a bit! All of our post-op hearts/valves have them, septic pts usually have one, some patients have them after major abd surgeries to manage fluid resusitation properly also traumas have them. I don't really understand why they are not being used lately by so many, how else do you have a good picture of the patient say who is septic? or a post-op of a huge surgery? I would say, study it, it is always good to know! :) I hope that helps some!

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Specializes in SICU, EMS, Home Health, School Nursing.

All of the open-heart patients in our CVICU have them post-op. We don't see them very often in the SICU or CCU though. We mostly see CVP and A-lines, but not swans anymore. I'm not sure exactly why the docs have been shying away from using swan lines, I have heard its because there really isn't much of a difference in mortality rate between those who did and those who didn't have one.

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I'm not sure exactly why the docs have been shying away from using swan lines, I have heard its because there really isn't much of a difference in mortality rate between those who did and those who didn't have one.

You're right, a study showed that swan vs. no-swan had practically no difference in morbidity & mortality. Swans seem to come and go. They'll be the in thing for a few years and then die down for a few and then make a come back. I think that typically you will see the majority of swans in CVICU/CTICUs and Trauma ICUs

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Specializes in Dialysis.

But how much is physician reluctance to use a pulmonary artery catheter because of the perception the nursing staff can't manage it? Does anyone know how to graph a waveform and find end expiration point? Find the A wave and the V wave? Know what to do when a catheter becomes stuck in wedge? I'm sorry, but I find this as more evidence of the dumbing down of nursing and structuring knowledge to the lowest common denominator.

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But how much is physician reluctance to use a pulmonary artery catheter because of the perception the nursing staff can't manage it? Does anyone know how to graph a waveform and find end expiration point? Find the A wave and the V wave? Know what to do when a catheter becomes stuck in wedge? I'm sorry, but I find this as more evidence of the dumbing down of nursing and structuring knowledge to the lowest common denominator.

I'm not too sure what to make of this post...are you venting about the physicians' perception of nursing knowledge, or actual nursing knowledge?

I DO know how to graph a waveform and find the end-expiration point (peak=patient, vent=valley). All measurements should be taken at end- expiration. The A and V waves are present on PAWP waveforms; in comparison to the EKG strip, the A wave comes right after the QRS complex and the V wave comes right after the T wave. It' important to know this because the only way to measure anaccurate PAWP is to take the mean of the A waves. Taking the mean of all the waves (A, V and C) can give you an extremely inaccurate PAWP measurement depending on the waveform.

Sufficient?

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Specializes in Dialysis.
I'm not too sure what to make of this post...are you venting about the physicians' perception of nursing knowledge, or actual nursing knowledge?

I DO know how to graph a waveform and find the end-expiration point (peak=patient, vent=valley). All measurements should be taken at end- expiration. The A and V waves are present on PAWP waveforms; in comparison to the EKG strip, the A wave comes right after the QRS complex and the V wave comes right after the T wave. It' important to know this because the only way to measure anaccurate PAWP is to take the mean of the A waves. Taking the mean of all the waves (A, V and C) can give you an extremely inaccurate PAWP measurement depending on the waveform.

Sufficient?

Maybe I've been in Memphis too long. I have only encountered one other nurse here that knew these things and she was from Canada.

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Maybe I've been in Memphis too long. I have only encountered one other nurse here that knew these things and she was from Canada.

Didn't mean to sound rude, but come on, you've gotta put some faith in your fellow CC nurses! If you work with nurses who don't know this stuff, then please, educate them. Maybe they won't like it at first, but it will improve their practice tremendously--not to mention make them seem more credible to the docs. Where are you from originally? Sounds like you haven't been in Memphis forever...

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Specializes in Dialysis.
Didn't mean to sound rude, but come on, you've gotta put some faith in your fellow CC nurses! If you work with nurses who don't know this stuff, then please, educate them. Maybe they won't like it at first, but it will improve their practice tremendously--not to mention make them seem more credible to the docs. Where are you from originally? Sounds like you haven't been in Memphis forever...

Minnesota, California, then here for the past 20 years. I have worked in nearly every hospital in this city that cares for adults and belong to the local AACN chapter. I have tried to stay at hospitals that were associated with the University of TN and it's medical training program because teaching hospitals seem to give nurses more respect. I'm all for education because I do enjoy this profession but if I had a dollar for every time I was told by staff "we don't wedge here" I could retire. When I ask why I'm told because Dr So and So doesn't want us too. Ask Dr So and So and it's what medical school did you go to? And if they do obtain a wedge pressure it is by pressing a button on the monitor, pushing on a syringe, and charting the number displayed. I have even seen negative PA pressures charted.

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Minnesota, California, then here for the past 20 years. I have worked in nearly every hospital in this city that cares for adults and belong to the local AACN chapter. I have tried to stay at hospitals that were associated with the University of TN and it's medical training program because teaching hospitals seem to give nurses more respect. I'm all for education because I do enjoy this profession but if I had a dollar for every time I was told by staff "we don't wedge here" I could retire. When I ask why I'm told because Dr So and So doesn't want us too. Ask Dr So and So and it's what medical school did you go to? And if they do obtain a wedge pressure it is by pressing a button on the monitor, pushing on a syringe, and charting the number displayed. I have even seen negative PA pressures charted.

Unfortunately, I have seen all of these things too (and I've only been practicing a few years!). When I first started in SICU as a new grad, I was told "we hardly ever wedge here, esp not open hearts, we never wedge open hearts". A few months down the road, one of the attendings asks me why I haven't obtained a wedge pressure--turns out we DO wedge after all. That prompted me to seek out more information on my own and not rely so much on my co-workers. I want to know the CORRECT way to do things, not the "usual" way. I have learned a ton while studying to take the CCRN exam, and I would urge anyone to do so. It's made me look at the things I do everyday in greater detail and TRULY understand it.

Actually, I shouldn't say that I do these things everyday, b/c I don't anymore. I was SICU for a few years then went to cardiology to "see what it's like" somewhere else. I've learned a lot, and it's opened my eyes to the realm of non-critical care, but I miss ICU so much! Going back soon, I think.....

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Specializes in CVICU, MICU, CCRN-CSC.

Our hearts rarely come back with swans. Maybe one a week out of 16-18? Many times we have a "Double Stick" that we could float a swan into if needed, but we don't do that often at all (maybe once in my 6 years there). Sometimes we will put in one on a patient we brought up open that "won't make it make it an hour" when they were brought from the OR "to die"...because we all know they DO NOT DIE IN THE OR, and they live for several more days (then are on CRRT, all pf the wpnderful things we have to offer). I wish they came up with them more.

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Specializes in Dialysis.

"I want to know the CORRECT way to do things, not the "usual" way"

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Why do people want to wedge so badly? The PAD usually correlates and if it doesnt and they're that sick I get a LA line at my new gig. I guess thats the one advantage to the ivory tower.

I just don't understand the romanticism with wedging :/

PS: To stay on topic. The PP hosp i worked at used swans on 90% of their cases except softball cases where they didn't even bother placing epicardial wires. The academic hospital I'm now at uses them somewhat but often times they come back with LAs.

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