Are swans going "out of style?"

[TemperStripe]

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 very near future. Anyone have any experience with any of these? Are you actually seeing fewer swans?

[WalkieTalkie, RN]

I've also heard this regarding systems such as Vigileo, but I have not seen the devices in use yet. I'm very interested in these systems. We use a lot of Swans on my unit, but we rarely wedge or do manual cardiac outputs. We typically just use the PAD in place of the wedge pressure. Of course, this isn't accurate in all patients, but the thought is that we're putting the patient at greater risk by wedging.

http://www.cheetah-medical.com/publications/Publications-files/CM-NICOM_Disease-Management.pdf

http://ccforum.com/content/13/2/R32

I'm really interested in learning more about these minimally invasive systems in the future.

[schroeders_piano, RN]

There is actually 2 really neat pieces of equipment that you can get cardiac outputs with. One is a monitor that connects to an art line. The other is an esophageal(sp) doppler. It looks like an NG tube and is placed the same. It uses doppler waves and can calculate a number of hemodynamic monitoring parameters.

Use of Swans tends to come and go. They're in fashion for awhile and then they go out of fashion.

[Hoozdo, ADN]

Swans are definitely out of fashion in my area. I have been using only Vigileo equipment for about 3 years. Very cool stuff.

[detroitdano]

I've only had one Swan since I started in the MICU in June '09. It was a septic patient who had a good sized MI.

Everyone and their mother who gets pressors seems to get a Vigileo nowadays. Maybe 25% of the time do we actually use them for changing therapy, seems 75% of the time they are just there to make sure their CO doesn't tank.

[moonischasingme1]

I'm still new to my unit, but i've been told that we rarely get swanz anymore. They all use Vigileo and other cardiac output machines.

[Cursed Irishman]

In my CV-ICU, all hearts come back w/ a swan.

[AmyCardsNP, RN, NP]

It seems to me that the use of Swans depends on the physicians in the unit. I primarily work in a CVICU and all of our patients come back with swans in place s/p open heart surgery. Although, when we have patients with huge MIs (that could benefit from the knowledge behind a swan) who were in the cath lab, the cardiologists often prefer not to place a swan (comfort level possibly?). We ask the physicians if we can use the vigileo, which hooks up to a radial arterial line to measure cardiac output and most physicians will agree.

When I float to the medical ICU, they never use swans... ever. We actually had one of the MICU nurses call to the CVICU when they needed to remove a swan a couple years back because no one on the unit felt comfortable with the skill set. (which I think is a good thing to call for assistance if you're unsure, for the record)

http://nursinginfluence.com

[hypocaffeinemia, BSN, RN]

We barely swan or do any CO monitoring at all. An occasional sepsis patient, less than 1 a month. Of course, we're starting to do CV in the next few months and will have to quickly become more proficient with them.

[fiveofpeep]

Ive had an md have us pull the swan because we kept getting really crappy values for 12 hours straight and the patient wasnt exhibiting any signs of decompensation. His rationale was it's better not know . I like to know.

[meandragonbrett]

Use them on a daily basis. Busy surgical ICU and a busy Trauma ICU. We have flotracs and all of the other fancy devices sitting in a closet but we still float swans frequently.

[RedCell]

ive had an md have us pull the swan because we kept getting really crappy values for 12 hours straight and the patient wasnt exhibiting any signs of decompensation. his rationale was it's better not know . i like to know.

hey man, you cannot find a fever if you do not take a temperature! it worked for the fatman at least. maybe your physician is on to something. one of the old school ct surgeons i work with always wants them placed in his hearts regardless of the specific patient conditions. i think it is overkill being that i have direct visualization of the heart and a tee is in place. however, he says they help him with management of the patient in the icu. since it is his patient, my group is happy to comply. it is my opinion that certain situations do call for pa tracings and until there is a superior and more cost effective tool on the market, we will continue to see swans in our patients.