PatriceM

IABP's in our busy CCU are d/c'd by the caridiac fellow or the PA. After which a femstop is applied. After 30 minutes to an hour or if the RN is concerned, the technician (PA or Fellow) returns to decrease the pressure in the femstop or if bleeding is severe--hold pressure. It is not that nurses cannot do this--it is that we do not place IABP's and therefore we do not d/c them. That is the policy with all lines. If we do not place them--we do not remove them. Kinda simple-but that is it.

A pulmonary artery occlusive pressure (wedge) is best done after any therapeutic intervention to determine its effectiveness. Also the lifespan of the balloon is only 72 wedges. The paop should be compared to the pad and determine if they are correlating. A pad may be used to determine the paop. All paop should be read from the end expiration. A patient that is not vented should be read at peak, and a vented patient at valley. (P-peak (patient) and V-valley (vent). A PA line can be a very handy determinate of patient therapy--but only if read right. Good luck with determining a policy. A PAOP should be read with interventions. On our unit, with tailored therapy for our cardiomyopathy patients, these measurements provide a guide for medications. That is exactly how all PA pressures should be done! :)

After many years I have learned to take a vacation in the early summer. However, I often have to check myself when the younguns walk in. They are so humble that I need only remind myself of June--then they don't even give a hoot. Well, the most recent youngsters have planted themselves in our ICU. They have to assist the nurse on transport to CT scan with a patient with a faulty temporary pacemaker. When I advised the young lass not to touch it--just transcutaneously pace, (preferred over rupture cardiac tissue!) she just nodded and vehemously agreed. Thank goodness for interns--they have so much to learn and in a very short time they become know it alls!!!