Questions about PA pressures

allnurses Guide · Sep 20, 2009

People don't do wedges a lot anymore because

1. There's a chance of PA perforation/rupture or balloon entrapment

2. There's no evidence that using PCWP to guide therapy has a positive impact on patient outcomes over any other less invasive parameter.

What's the point of measuring it if noone is going to interpret it?? Especially with the risks v benefits? I'm a cardiac nurse and I love my numbers, but I have had to bow to the evidence on this one. In fact there is little evidence that using SGCs in post cardiac patients improves outcomes, which is hard to believe.

PAD is "good enough" to estimate LAP, which is a good indicator of worsening HF. You really just want to see: is the LV pumping? is there fluid overload? how much? LAP is a good surrogate for LV function as long as you have a competent MV.

I would suggest further reading - there's a lot of articles about invasive hemodynamic monitoring. You're smart to learn it well - it's one of the most used and valuable pieces of knowledge in critical care.

Here's a PPT I see online: Hemodynamic Monitoring

hypocaffeinemia, BSN, RN · Sep 20, 2009

The fact that swans are used at all anymore when adequate NICOMs exist is an affront to logic.

allnurses Guide · Sep 20, 2009

Well, NICOMs have a lot of asterisks to their reported accuracies. Depends on your patient population.

chare · Sep 21, 2009

the pulmonary artery catheter education project is available on line.

there is a free registration to access site.

Editorial Team / Admin · Sep 21, 2009

:yeahthat:

aCRNAhopeful · Sep 21, 2009

Thanks alot. I have began to go through the pacep.org lessons which are great but just haven't had enough time to complete them. I will definately adding this info to my knowledge base soon. I think this stuff is fascinating

highlandlass1592, BSN, RN · Sep 22, 2009

May want to consider picking up Kathy White's fast facts for adult critical care..she's got a great section on hemodynamics I use as a reference for mentoring.

RedCell · Sep 24, 2009

the fact that swans are used at all anymore when adequate nicoms exist is an affront to logic.

i don't know dude, i would think about revising that statement. just today i put a heart to sleep. guy was 80+ years old getting a cabg, mvr and maze. had a hx of a-fib, significant pulmonary htn and a preserved ef based on his echo. couple of other expected comorbidities. a-line placed preinduction and hooked up to a vigileo. i thought that maybe the co/ci and svv numbers would be more useful being that the dude was rate controlled in the 70's. that thing proved itself to be absolutely useless and inaccurate. tee completed by anesthesiologist confirmed vigileo inaccuracy. i put in a pa catheter after induction and got more reliable numbers. used it to guide pharmacologic and fluid replacement throughout the case. especially coming off bypass. i don't care what any evidenced based study shows. this gomer benefited from a swan and that is definitely not an 'affront to logic'.

hypocaffeinemia, BSN, RN · Sep 24, 2009

OR and ICU are different monsters, I'll concede. Most of the ICU swans are just number generator risk devices with little practical relevance.

CCRNCCU2008 · Sep 28, 2009

we do not wedge (often) at our hosptal do to one of our cabg pt's dying from pa rupture when wedging. Also a wedge doesnt really give you a bigger picture compared to the rest of your numbers

Manurse715 · Sep 29, 2009

OR and ICU are different monsters, I'll concede. Most of the ICU swans are just number generator risk devices with little practical relevance.

I will contribute that this maybe because many nurses don't know the significance of the numbers that are produced.