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 Dialysis.
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 :/

Mitral regurg for 500 dollars, Alex.

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I work in a pretty big ICU in Baltimore and I think I have seen one SWAN since I have worked here (over a year). Typically we use PICCO.

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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 :/

The PAD correlates to the PAWP in a "normal" heart. There are many instances in which the PAD is not reflective of LVEDP, such as mitral regurg/stenosis and aortic stenosis, to name a few. With mitral stenosis, for example, the pressure in the left atrium is really high because it's working so hard to pump blood through the stenosed mitral valve into the left ventricle. So your PAD measurement will be much higher than what your actual LVEDP is, so really a wedge pressure is the only way to know exactly what's going on in the LV.

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Specializes in ICU.

We have started using the Vigileo Machine and obtaining the same info as a swan (except for a wedge pressure). It works via a TLC on the distal port and/or A-Line and only if the pt is intubated. Pretty cool!

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the pad correlates to the pawp in a "normal" heart. there are many instances in which the pad is not reflective of lvedp, such as mitral regurg/stenosis and aortic stenosis, to name a few. with mitral stenosis, for example, the pressure in the left atrium is really high because it's working so hard to pump blood through the stenosed mitral valve into the left ventricle. so your pad measurement will be much higher than what your actual lvedp is, so really a wedge pressure is the only way to know exactly what's going on in the lv.

mitral regurg for 500 dollars, alex

the pad usually correlates and if it doesnt and they're that sick i get a la line at my new gig

thank you both :icon_roll :icon_roll :icon_roll

any other pearls of wisdom you wish to impart on me?

i've been doing open heart for years taking care of vads, double valves, triple valves,robotic valves, thoracic aneurysms, aaa, cabgs with efs in the teens, aortic roots, heart and heart + double lung xplants, you name it and have never wedged. yes it has its place, but i don't lay awake at night crying because i can't wedge. a wedge won't tell me much i can't figure out other ways, though i am spoiled by the laps i see so often now.

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Thank you both :icon_roll :icon_roll :icon_roll

Any other pearls of wisdom you wish to impart on me?

I've been doing open heart for years taking care of VADS, double valves, triple valves,robotic valves, thoracic aneurysms, AAA, CABGs with EFs in the teens, aortic roots, heart and heart + double lung xplants, you name it and have never wedged. Yes it has its place, but I don't lay awake at night crying because I can't wedge. A wedge won't tell me much I can't figure out other ways, though I am spoiled by the LAPs I see so often now.

I meant no disrespect--and certainly I don't question your experience and/or knowledge. Just trying to help others understand, that's all, isn't that what this forum is intended for? Maybe you know all these things already, but I'm sure there are people reading this thread who didn't. My comment wasn't directed at you, I simply quoted you so that my post would be relevant and others would know what I'm referring to. And by no means do I claim to know it all, far from it! That's the reason I even visit this website is to learn from people. I've never shed a tear over a wedge pressure, either, and I sure hope there isn't anyone who has.

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Specializes in Dialysis.

Topher, can you cite an article or reference text that supports not measuring PAW because PAD usually approximates wedge? It's so easy why would you not want to measure it?

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Here is a link to an abstract discussing PAWP and PADP relationships. Anybody have any other literature?

http://www.ncbi.nlm.nih.gov/pubmed/3395235

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It's true that it's easy to measure, but there is always a risk of rupturing the PA. We rarely wedge.

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Topher, can you cite an article or reference text that supports not measuring PAW because PAD usually approximates wedge? It's so easy why would you not want to measure it?

I don't think it necessary for me to go browsing pubmed to 'prove' that PAd approximates PAWP in a NORMAL heart. That is common knowledge and I am far too busy. This text was handy so on pg. 211 of "Hemodynamic Monitoring: Invasive and Noninvasive Clinical Application 3rd Ed" by Gloria Obkouk Darovic it states:

"During systole, no correlation between pulmonary artery pressure and left atrial pressure exists because of the systolic thrust of blood from the right ventricle. PAd pressure, however, is normally 1 to 4 mm Hg higher than left atrial pressure because of the slight resistance to diastolic runoff imposed by the friction of flowing blood against the highly distensible pulmonary vascular walls."

I never said 'DONT EVER MEASURE PAWP BECAUSE PAD IS THE SAME'. Im saying PAWP is a reflection of LAP, it isnt even an exact measurement. And in a cardiopulmonary system with near normal physiology PAd closely correlates.

Yes I know when stenotic or regurgitant valves are involved it won't.

Hell I could probably find 10 articles citing that PACs increase morbiity and mortality and should be used sparingly.

Nice abstract, you bother to notice it was from 1988?

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Specializes in Dialysis.

can you tell me where i can find patients with a "cardiopulmonary system with near normal physiology"? i deal with uncontrolled hypertensives, septic patients not responding to fluid challenges, and liver transplant patients. if i relied on your assumptions about hemodynamics i would miss quite a few pad/ wedge mismatchs.

some of the comments posted in this thread simply reinforce what the aacn pointed out along time ago, there is alot of nursing ignorance associated with pa catheters.

"during the past 12 years, at least 6 studies or evaluations5-10 of critical care nurses’ knowledge of pa pressure monitoring have been done; mean test scores ranged from 31% to 65%. the lack of knowledge indicated by these studies is of concern because pa catheterization is one of the most commonly performed diagnostic and monitoring procedures in critical care.

numerous research-based guidelines for pa pressure monitoring are available.47,54,55,123 despite the availability of this large body of literature related to pa pressure monitoring, critical care nurses continue to demonstrate insufficient knowledge and ability to apply information related to the collection and interpretation of data obtained with a pa catheter."

my point is that maybe some of the decline in the use of pa catheters is directly related to lack of nursing expertise with them.

http://www.aacn.org/aacn/jrnlccn.nsf/c54ad59fdf5d6228882565a0006a1369/29c97ed9556d4978882569a8000c6a44?opendocument

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Specializes in Dialysis.
I never said 'DONT EVER MEASURE PAWP BECAUSE PAD IS THE SAME'.

Yes, you did imply that.

Why do people want to wedge so badly? The PAD usually correlates
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