PAWP readings

[dewp_63]

I'm looking for information about standards ralated to manual wedging of PA caths and frequency of such. We are having a "war in our facility about frequency of wedging in absence of direct MD order. Some of the nurses feel that the PAWP should be obtained every 4 hours, while others of us seem to remember reading that PA cath balloons have a limited number of "safe" inflations, and that obtaining a PAWP is an invasive procedure. Our facilities policies and procedures are very vague, referring to a Manual of Nursing Practice (published) that we don't even have a copy of. I am concerned, especially as I work the night shift and we are often not using these numbers to direct treatment, we are just "filling in the blanks". Any feedback will be greatly appreciated!

[Cheryl ~ STH]

Thanks Cindy,

Our Doctors have written standing orders for us to follow. We pull back to CVP when our CABG patients are extubated. I have been caring for a long term patient with IABP (over 10 days). We diuresis and titrate based on the PCWP and CVP. The goal is to get the numbers down to wean off the IABP. The Doctors/Residents make frequent rounds to monitor.

Thanks again for the info

Cheryl

[J_W, DNP, APRN, CNS]

On the vented vs spontaneously breathing patient. If your vented patient is overbreathing the vent then it is considered a spontaneous breath and you would read the PAWP at the peak not at the valley. Whereas ventilator breaths are read in the valley. I just learned this last Fall from Dr. Tom Ahrens. So unless your patient is paralyzed then be sure to watch whta type of breath your patient is taking is it spontaneous (their own initiated breath) or ventilator forced breath....Hope this helps. As far as how often to wedge. I learned every 4 hours. Then learned whenever you thought the patient needed it(change in condition, BP, HR, etc.). I would suggest talking to the surgeons or cardiologists who most often use Swans how often they would like PAW readings.....Then take it to your manager to be looked at when and if your policies are reviewed..........Just my .02 worth

[sharann, BSN, RN]

A good site (free) to learn all about PA's and such is

http://www.pacep.org

Just a tidbit. I've looked into the site and it seems pretty decent.

[New CCU RN]

Wow, I am surprised to learn of the frequency of wedging at other places! Where I work we wedge q2h and even more often if needed. However, our patients generally do not have a Swan for more than two or three days. We do have a very high acuity of patients and alot of times the PA diastolic does not correlate with the wedge pressure. We generally treat off the wedge.