I am working in MICU and also studying critical care nursing.
As far as I know, It's a trend that PA catheter is not used anymore as much as it used to be in the past.
But my question is, when you study cardiovascular chapter in the books,
a large proportion of contents still covers hemodynamic parameters which can be obtained by PA catheter. (PAOP, Pumonary artery pressure, PAd, PAs, etc.)
So I am kind of lost how much I should put my efforts into this topics.
(I know I need to study hard but I don't think I can digest all the stuffs without some efficiency!)
Specializes in Adult and pediatric emergency and critical care.
For the record there are many alternatives to PA catheters.
I've use the flotrac on quite a few adults and have found it to be very easy to use and the risks with an A line are much lower than a PA cath. With the clearsight attachment we can even use them on crashing patients before we have an A-line placed.
On kids we will use RA and LA lines and calculate out the pressure difference and with a A line correlate their cardiac function. This requires more intuition and experience and doesn't provide solid numbers to base treatments off of, but we have been very successful with them.
There is also a lot of value in bedside echos, and give far more information than can be provided by a pa cath, it does come with the limitation that you have to have very experience providers available to interpret the echo, but can give us far more insight into the need for surgical versus medical stabilization for the deteriorating patient.
There are many other monitors and techniques as well, though I'm far less experienced with them.
In reality I've never used a PA cath, and our unit only sees about one a year (and mostly snagged up by the old-timey nurses). They are largely a vestige of the good old days, and with time I think that they will go away entirely. Unfortunately they are still very present in the adult CCRN exam and do seem to be a bar that we measure ICU nurses against. I was able to study enough about them to pass the exam, but I wouldn't consider myself an expert in them by any means.
I do find it odd that especially with the development of drug eluting stents we have seen so many fewer adult open hearts, and therefore PA caths, and yet it is something that apparently we expect all ICU nurses to understand. They have never really been that prevalent in pediatric CV, and yet peds CV programs generally have great surgical recoveries.
I think it also comes down to clinical area. Because I work in open heart surgery, I would say anywhere between 30-60% of our patients will have PA catheters.
We regularly use PA pressures, cardiac indices, and PA sats to help us tailor our treatments.
Now would I say the numbers featured on the CCRN and other study materials match exactly to how we operate, no - but it does get the general idea of the physiology and nursing considerations.
In terms of studying - know the "perfect world" numbers and then you can probably figure it out from there.
Example:
Textbook PA Pressures: "quarters over dimes" 25/10
Cardiac Index below 2.5? Too Low, need to do something about that
There's also some helpful youtube videos out there if you like to study that way
PeakRN
547 Posts
For the record there are many alternatives to PA catheters.
I've use the flotrac on quite a few adults and have found it to be very easy to use and the risks with an A line are much lower than a PA cath. With the clearsight attachment we can even use them on crashing patients before we have an A-line placed.
On kids we will use RA and LA lines and calculate out the pressure difference and with a A line correlate their cardiac function. This requires more intuition and experience and doesn't provide solid numbers to base treatments off of, but we have been very successful with them.
There is also a lot of value in bedside echos, and give far more information than can be provided by a pa cath, it does come with the limitation that you have to have very experience providers available to interpret the echo, but can give us far more insight into the need for surgical versus medical stabilization for the deteriorating patient.
There are many other monitors and techniques as well, though I'm far less experienced with them.
In reality I've never used a PA cath, and our unit only sees about one a year (and mostly snagged up by the old-timey nurses). They are largely a vestige of the good old days, and with time I think that they will go away entirely. Unfortunately they are still very present in the adult CCRN exam and do seem to be a bar that we measure ICU nurses against. I was able to study enough about them to pass the exam, but I wouldn't consider myself an expert in them by any means.
I do find it odd that especially with the development of drug eluting stents we have seen so many fewer adult open hearts, and therefore PA caths, and yet it is something that apparently we expect all ICU nurses to understand. They have never really been that prevalent in pediatric CV, and yet peds CV programs generally have great surgical recoveries.