I'm reviewing for the Canadian Nurses Association certification exam in pediatric critical care. There's a lack of Canadian resources for this exam, and I had to miss the webinar that CNA provided for examinees because I needed to sleep after nights more than I needed the webinar. So now I'm using some rather dated resources obtained from a friend who wrote the AACN certification exam about 7 or 8 years ago. I'm lost when it comes to the questions related to pulmonary artery catheters and pressure measurements because we don't use them. In the 10+ years I've been on my current unit (a mix of CV, solid organ transplant and general PICU patients) I've seen exactly one. (We monitor left atrial pressures in most cardiac surgical patients and right atrial pressures in those with pulmonary hypertension instead.) They've fallen out of favour in the adult world due to high cost for low return. I'd hate to just assume that the exam won't have much on it related to them and then get there and find out how wrong I was! My question to all of you is - does your unit still use them?
Apr 2, '13
My unit will use them if the kid has a high affinity for severe PH crisis pre-op, and it's usually surgeon dependent. They are usually pulled w/in the first 12 hours (and almost all our post ops typically have both RA & LA lines). The first time I had one I thought it was the coolest thing ever (newbie still on orientation). Kiddo started having elevated PA pressures before any other symptoms, BP, sats, RA & LA pressures were all ok, in fact during the first 30 seconds or so we were trying to trouble shoot the line thinking that it couldn't be right when the attending shouted at someone to get the nitric on and for us to sedate/paralyze her. Pressures came down almost immediately with the nitric and she completely missed a PH crisis that we otherwise would have missed until she was in to far and was dropping sats/hr/bp.
That being said in the two years of being on my unit I have seen them only 3 times.
Apr 3, '13
I've never seen them on my unit, but granted cardiac surgery isn't a huge part of our patient population.
And Jan, the CCNA in the US provides access to the archived webinar if you've paid for the course and aren't able to view it live. Maybe you can find it online?
Apr 4, '13
I have only seen 1 on my unit. Generally they aren't used at all we use the non-invasive cardiac output monitoring (NICOM) machine, which gives the same numbers, just probably not as accurately.
Apr 5, '13
just happened to have one in our unit today, sutureless repair for pulmonary vein stenosis
Apr 14, '13
Thank you for your responses. The more I read about PA catheters, the more I'm convinced that there are safer ways of obtaining the same information. Pulmonary artery wedge pressure is basically left atrial pressure, which we measure routinely in most of our cardiac surgical patients with very few complications. For a while we were trialling a central line (PediaSat) and monitor (Edwards Vigileo) that measured ScVO2 continuously as well as using NIRS monitoring of regional perfusion. I'm not sure why I haven't seen these in a long time, but I haven't. Maybe the study they were brought in for is over... I don't know. (I haven't seen the mass spec or the gas chromatograph at a bedside lately either.)
Apr 14, '13
I don't know why our surgeons put them in. 90% of the time if the number is too high our doctors choose "not to see it" kind of defeats the purpose