Swan Ganz Cath Question

[bwt02]

It is standard practice in the Trauma/Burn ICU that I work in to use iced injectate solution with the coefficent set accordingly. It seems to me that this iced solution could very well be stunning the myocardium in a heart that is already comprimised (Cardiac or Septic Shock). Just wondering what the standard is in other facilities.

[Trauma Tom]

In the SICU where I worked we did not use iced injectate, however instead of NS we were taught during our critical care course to use D5W. Anyone else ever hear this?

[EmeraldNYL, BSN, RN]

We use D5W. Not sure of the rationale for using that over NSS though, I'll ask my clin. spec.

[TraumaNurse]

When I started in ICU 9 years ago, they had gone away from the iced injectate. Most of the places I have been since use CCO but my most recent employer is still using ice (although they are talking about changing...it's about time!)

As far as I know, 5cc of D5W is used when using Ice but 10cc is required for injection if using room air. I still prefer CCO.

[zambezi, BSN, RN]

We use room temp NS

[catcolalex]

i've been in several icu's and never even heard of iced injectate, i personally think that injectate is old, cco's are much better. do they still make you wear white stockings and starched hats?

[louloubell1]

i've been in several icu's and never even heard of iced injectate, i personally think that injectate is old, cco's are much better. do they still make you wear white stockings and starched hats?

We generally use CCOs too, except on the rare occassion that specifically calls for having to shoot cardiac outputs instead (like a patient with a heparin allergy since the CCO caths we use are heparin coated, or if for some reason we truly doubt the readings we're getting with the CCO and they don't FICK out either). When we do shoot COs our facility policy is to use iced injectate, but I have read articles which tout the advantages of using room temp injectate. I'll see if I can find any of these articles to post links to here. We also use D5W when we shoot them, NS for the CCOs. I'm not sure of the rationale for that either.

[Zinnia]

We do not use the iced injectate either, but still stock the equipment for it. I have only used it as a trouble shooting method, when things are not working. Usually just getting a cool IV bag off the shelf is all it takes.

I have heard of the continuous CO machines, is it hooked up with pressurized lines like the art/CVP lines are now?

[UCDSICURN]

I have heard of the continuous CO machines, is it hooked up with pressurized lines like the art/CVP lines are now?

Our facility uses the Vigilance CCO machines. It's pretty much the same, pressure lines to the PA and CVP ports of the swan with the transducers connecting to our monitors via the interface cable. In addition to this there are three more cables that directly connect from the swan to the CCO machine.

Hope this helps.

Donn C.

[Zinnia]

I am having trouble visualizing all these cables. Does this impact patient mobility at all? Is it anymore problematic than the usual ICU lines?

I work in a small rural ICCU, nine beds, where docs are not putting in Swans like they used too. You have a link or something I could learn more about this?

[louloubell1]

I am having trouble visualizing all these cables. Does this impact patient mobility at all? Is it anymore problematic than the usual ICU lines?

I work in a small rural ICCU, nine beds, where docs are not putting in Swans like they used too. You have a link or something I could learn more about this?

I don't think the extra cables and such are all that much trouble. As far as patient mobility goes, we may be getting someone up to the chair that is still swanned, but they're not going to be strolling around the unit until its out anyway, so it really isn't much affecting mobility.

[TREBORICUNURSE]

Hi,

We use swan`s and PICCO method for hemodynamic mesurement in our ICU.

For swan`s thermodilution, room temp. injectate is OK. Swan`s thermodilution is simple ( thermo sensor on Swan`s CO line - right heart - pulmonary art. - thermo sensor on Swan`s distal line inside pulm. art.)

But, for PICCO thermodilution ice cold injectate must be used. Injectate temp must be under 8°C ( best 4-6°c ).

PICCO method use transpulmonary thermodilution tehnique ( thermo sensor on CVC - right heart - lung - left heart - system circulation - thermo sensor on PICCO art. catheter ). It`s a long way for room temp injectate. So, injectate must be icecold temp.

WARNING!!

Before PICCO thermodilution with ice cold saline ATROPIN, ADRENALIN and LIDOCAIN must be prepared. Bad heart rhytam, bradicardia and even cardiac arrest is possible complications of thermodilution with icecold saline. Last year we had 3-4 CPR after PICCO thermodilution.

[CRNAStudent]

I have heard conflicting stories on the NS/D5W debate for CO/CI injectate. During my critical care class during orientation, I heard that you should always use D5W because you are rapidly injecting 10cc into the heart, and the sodium content in NS can "stun" the heart. However, many other nurses have told me that it really doesn't matter, then research has shown that there is no difference in outcomes as far as D5W or NS. However, hospital policy where I work is to use D5W, and call me superstitious, but whenever I come onto my shift and see that the RN before me has used NS, I change the bag over. (And we do not use iced injectate).