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Discussion

Need help ASAP: question re: Swan

Hi there. I'm a relatively new CCU nurse and we rarely get Swans on our unit. Our wonderful resource nurse who we usually call on for on the spot inservices in these cases is out on leave.

I need to know:

For the clamp (that little one that slides back and forth) on the line leading to the syringe used to do wedge pressures, should it be open- so we can watch for blood to back up into it, in case of a balloon rupture? as I was told by one RN, or closed to protect against the syringe coming off and possible air embolism as I was told by another.

Trying to find the answer but having no luck. I'm going back in with the patient tomorrow and would like to make sure I'm doing this correctly.

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    • Featured Replies

    I have never heard of leaving it 'open' to visualize blood in case of balloon rupture. That seems like a fairly unreliable method to check for balloon integrity - I think you're more likely to figure that out when you can't wedge after significant repositioning and re-floating.

    Also, I believe the reason that you keep the toggle closed is to prevent unknown volumes of air from entering/exiting the balloon, which is a closed system. You won't need to worry about an air embolus unless your balloon is ruptured, which would open the system to the patient and potentially allow air to enter the bloodstream.

    Should the syringe come off and the toggle is open - air will not be sucked into the patient's circulation (assuming your balloon is intact), but it could alter the volume of air in the tubing/balloon which could potentially mess up your wedging down the road. Does that make sense?

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    • Author

    Thank you, that makes prefect sense and seems more logical than leaving it open. I'm trying to learn as much as I can about Swans and plan to request some additional teaching with the resource nurse when she returns to work.

    I love new opportunities and learning but this has been very stressful. Definately a case of the more I know, the more I realise I don't know :confused:

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    Closed. What if the syringe got under the pt or pushed in some how, ballon inflates, you don't look at monitoring when u leave the room. Ballon is wedged. If the balloon is left up a pulmonary infarction can occur. I included the website for a diagram of the swan in circulation.CV Physiology: Pulmonary Capillary Wedge Pressure

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    • Experts

    some people let the balloon deflate and then lock the hub- there’s alittle locking hub that they use to keep the balloon inflated while feeding thecatheter along into the patient - leaving the air in the syringe.

    i don’t like this myself – what if the hub were to unlock for somestupid unforeseeable reason – then if the patient rolled over on the syringe,the balloon might get inflated, and stay that way. i like to take the syringe off the open hub,which guarantees that the balloon is down, and then reattach the syringe empty.that way the air can’t get accidentally pushed into the balloon.

    you may like this resource about critical care as well as the link above.

    http://icufacts.org

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    I take all the air out of the balloon, lock the hub, empty the syringe of air, reattach the syringe and then open the hub again. This way air can escape if the balloon did not deflate all the way but the patient can't roll over and inflate the balloon because there is no air in the syringe.

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    Always always ALWAYS keep your balloon syringe empty and the clamp LOCKED. If you accidentally wedged that balloon when you turned your pt and didnt notice you'd have a major sentinal event.

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    I have looked for information on Swan's quite a few times in the past and I can say that there is little to no information specific to them on the net. I never found the answer to my question which is a not good.

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