Post-op TAVR's & Swans

[sjalv]

Hi all

I work in a CVICU where we get everything from CHF exacerbations to post-op TAVRs/CABGs. Our CABGs still come back with Swans & Art lines. However, the new practice at our facility is that TAVRs will no longer come back from the cath lab with Swans/Art lines in place as they previously did.

What does your facility do?

[offlabel]

PIV and arterial line for TAVR, A-line/ central line for open chest hearts. PA catheters for more than one valve repair/replacement or documented severe PHTN

[CCRN_CSC_0710]

Depends on the TAVR patient. Some come back with Swans and a-lines but some don't even come back with a Foley.

[Rose_Queen, BSN, MSN, RN]

We don't even put swans in all of our TAVR patients. Up to the surgeons and anesthesia to decide the criteria.

[sjalv]

Depends on the TAVR patient. Some come back with Swans and a-lines but some don't even come back with a Foley.

From what I understand, none of them will even come back with a Foley. I think all of them should have arterial lines because what if they're having bp issues and need to be on Cardene to protect the new valve? The anesthesiologist I asked who accompanied my last TAVR back to the room said none of them would be getting any of the aforementioned hardware. Perhaps it isn't so black and white but that's how it made it sound.

[offlabel]

As selection criteria becomes more broad, many will just come back with a piv.

[CCRN_CSC_0710]

I was really nervous too and wanted a-lines when we first made this transition. However, they won't send up the patient if they didn't feel comfortable with titrating Cardene based on NIBP. It has been working out well for us.

[offlabel]

From what I understand, none of them will even come back with a Foley. I think all of them should have arterial lines because what if they're having bp issues and need to be on Cardene to protect the new valve? The anesthesiologist I asked who accompanied my last TAVR back to the room said none of them would be getting any of the aforementioned hardware. Perhaps it isn't so black and white but that's how it made it sound.

These valves, since they're placed endovascularly, do not pose the same post op issues as open heart aortic valves do. There are no suture lines around the valve to leak at all, so if the pre-op BP was 150/80, that would be fine for a post op TAVR...Obviously not for an open AVR.

These are definitely game changers as far as immediate post op care goes.

[anchorRN, BSN, MSN, RN, APRN]

At my last duty section in San Diego where TAVRs were performed, they usually did arrive with a Swan but was DC'd once stable out of the OR. Ive been gone from that command about 7 months now so that practice may have changed.

[sjalv]

These valves, since they're placed endovascularly, do not pose the same post op issues as open heart aortic valves do. There are no suture lines around the valve to leak at all, so if the pre-op BP was 150/80, that would be fine for a post op TAVR...Obviously not for an open AVR.

These are definitely game changers as far as immediate post op care goes.

Thanks for that explanation, and you're right. Especially having taken care of open heart AVRs and TAVRs, the loss of all the hardware makes them a lot more low maintenance and seems to improve patient comfort. The relief on my patient's face when I told her she wouldn't be coming back from the cath lab with a line in her neck as she was previously told was apparent.