CVP and SV02 monitoring in the ED

Dixielee, BSN, RN · Mar 18, 2005

I personally think it is a waste of time and resources. The purpose of the ER is to stabalize, treat and transfer. Sepsis treatment can be begun in the ER with identification, i.e , labs, blood cultures, etc. Then IV fluids, antibiotics, intubation if needed, but these patients need to be transfered to ICU for further treatment and monitoring. Putting in a central line in the ER may be necessary, but monitoring needs to be done over a period of many hours to evaluate your treatment methods. Unless we want our ER's to be turned into long term treatment areas, I think it is a big mistake. We start the process toward treatment, we don't finish it. Leave that to someone else.

No, I am not "hiding" from a new wave, I just think it is not necessary.

kaycee · Mar 18, 2005

I agree with Dixielee. We don't have the time or staff to do invasive monitoring in our ED.

needsmore$ · Mar 19, 2005

i also agree with dixielee-

high pt-staff ratios that are always in flux make this unrealistic imo-ed staff not able to provide the intensive monitoring that is the standard that is given on ccu type floors due to the current ed working conditions-

i would be very concerned if this type of monitoring was placed in our ed and i still had to do 7-8 pts at a time when my ccu counterparts are doing 2.

anne

Salty1 · Mar 19, 2005

Is anyone doing CVP monitoring for septic patients in the ED ??
There seems to be a great move for this, the outcome of such pts has been improved greatly. The wave of the future is upon us.
How is it working for you ?? Is the staff hiding :chair: afraid of the new wave ?

I would suspect that the wave of the future, if that is what it is, might very well swamp a great many ERs. Placement of hemodynamic monitoring such as Swan-Ganz catheters is probably better suited to ICU which has a more stable environment in terms of nurse patient ratios. Most ED's diagnose, treat and transfer as quickly as possible. Perhaps I am missing something but the question arises as to how long the patient will be in the ER? Will the ER Nurse be able to record PAWP, etc., etc. and still have time for setting up suture trays, fitting patients with crutches, applying dressings, putting kids in papooses for suturing, and so on, to say nothing of the Cardiac Arrests, OD's and the accompanying chaos.

candyndel · Mar 19, 2005

We are not monitoring CVPs in the ED. This would not be a huge deal, but if you want an SVO2 measurement, you also have to put a Swan in as opposed to just a sheath (TLC) for CVP monitoring. I would fight this tooth and nail should they ever even think of putting a SGC in our ED!!

Several large, multicenter studies showed the risks of SGC usage far outweighed the benefit. The mean increase in mortality of the studies is 50%, amongst patients with similar disease states.

FIFTY PERCENT MEAN INCREASE IN MORTALITY....UGH!!

This is why the useage of SGC has greatly decreased. DONT LET THEM EVEN TRY IT!! If they are so worried about 02 consumption of the tissue, let them do lactic acid levels.

Is anyone doing CVP monitoring for septic patients in the ED ??
There seems to be a great move for this, the outcome of such pts has been improved greatly. The wave of the future is upon us.
How is it working for you ?? Is the staff hiding :chair: afraid of the new wave ?

Nurse Valium · Jul 11, 2005

Good morning all! I have a similar question/concern - what is standard practice in EDs when a patient is admitted to CCU with similar orders (ie CVP/SVO2 monitoring, vented) & they end up being held in the ER? Is additional staff brought in to care for these patients? ICU staff? Are all ER nurses out there adept at performing these tasks? The ED I work in does not require previous ICU/CCU experience and I was very clear when I applied that I do not have that experience. I have since been told that it is my responsibility to gain said knowledge. Nice, eh?

rjflyn, ASN, RN · Jul 11, 2005

CVP is one thing, Swan is another. One can monitor CVP fairly easitly with any central line and transducer. In my vast exp (17yrs) only one time was a Swan placed in the ED- incidently it was just this last month, the cardiologist wanted to place a transvenous pacer, and this was an old hospital with tiny ICU rooms- we had more room to work. I might add this is prob a level 2 or 3 ER. Beyond that most ER's dont have the resourses to give 1:1 care that this pt would continue to need longer than a couple hours.

Rj:rolleyes:

candyndel · Jul 11, 2005

No, no staff from ICU/CCU ever comes to the ED to care for the pts, even if they are "holds" bc they have no beds/staff on the units. Not only that, but we frequently hold critical care pts without the same staffing ratio they would get in the unit. Its a big problem holding ICU pts in the ED. (Although I did work at one union hospital who had to send staff to the ED if we had holds, but that was only one place i have ever seen it at!)

You wont see wedge orders or an order to draw & send an SVO2 for your pt in the ED bc they will almost never put a swan in while the pt is still in the ED. Many EDs do not even have the equipment to do so!! So I wouldnt concern myself with hemodynamics. However, vents are very common in the ED and you should get very comfortable with them. TVPs and multiple drips are also critical care commonalities that an ED RN needs to be proficient at.

Maybe you should request orientation shifts in the unit? We send our nurses there for vent training and they also spend time with an RT.

uir

Good morning all! I have a similar question/concern - what is standard practice in EDs when a patient is admitted to CCU with similar orders (ie CVP/SVO2 monitoring, vented) & they end up being held in the ER? Is additional staff brought in to care for these patients? ICU staff? Are all ER nurses out there adept at performing these tasks? The ED I work in does not require previous ICU/CCU experience and I was very clear when I applied that I do not have that experience. I have since been told that it is my responsibility to gain said knowledge. Nice, eh?

suzanne4, RN · Jul 11, 2005

I hope that it never comes to that. If the patient is that sick and there are no ICU beds available, then they need to be transferred to another facility.

CVPs are quite easy to monitor, just with a transducer, with a PA catheter you are opening a completely other set of worms and the nursing staff needs speciailized training for these. Don't let administration tell you otherwise.

barefootlady, ADN, RN · Jul 12, 2005

Agree with Suzanne and many others, simple monitoring of CVP in ED is one thing but more complex monitoring requires more complex training and more staff. No ICU/CCU nurses come to help when critical patients are held, it is a case of do the best you can do and pray the patient is moved quickly. The doctor or CN usually pushes for the patient to get to the proper unit as quickly as possible.

While I hope with wave is a long time coming, when I look back just a few years, things we do on the floors now, were ICU procedures a few years ago. Lets just all push for up to date training and support from our HN, CN and supervisors while we can before the wave of the future creeps up on us.

mommatrauma, RN · Jul 12, 2005

We do CVP monitoring...not that often but we do it...mostly for our symptomatic hypotensive dialysis players, or our septic shock with multiple co-morbidities ...making sure we aren't overloading them with fluid vs needing a pressor...We do not do swan monitoring in the ER, that is a little over the top for the capacity an ER works in...However I think CVP monitoring is becoming more the standard than the exception...