swan lines

[melinated]

do u feel comfortable using swan lines? what is ur hospitals protocol for checking proper placement? reason: grandmothers pulm art was ruptured during a wedge pressure check. i am a nurse, but not ICU knowledgable...just lookin for opinions. THANKS!

[dorimar, BSN, RN]

Sorry LCRN. I did not mean to imply PA rupture was ALWAYS deadly, nor that you did anything wrong by wedging. I only meant that PA rupture is the most dangerous complication (70% mortality rate on a retrospective study from Cedars-Sinai Medical center). That being said, i believe that as long as a nurse has specific orders to wedge, it greatly reduces her liability if said PA rupture happens. Sorry for the mis-communication.

Doris

[MommyandRN]

I have used swans alot, they are used alot in critical care when people are septic - trauma, post op etc. Generally every 4 hours unless ordered other wise. I have seen "do not wedge" orders if the dr thinks the placement is questionable.

I've never seen a rupture. But what I do know is this: the way the syringe attached to the swan comes in the packaging, it shouldn't be removed or maniplulated. The syringe is attached with 1 1/2 cc of air. That is the amount that the ballon needs to inflate. When you push it in, it inflates, and to deflate, you dont need to pull back much, it just fills back up. I was taught to NEVER take off the syringe. If you take it off there is a risk of TOO MUCH ARE BEING INJECTED! The ballon then would burst, casuing air to go into the bloodstream or rupture of the PA.

I have arrived on a shift and seen a pt's swan with the syringe all the way closed, but attached to the swan. In that case, I would not touch the syringe and NOT WEDGE! PUt some tape on it, notify the MD. The syringe should always be left with the 1 1/2 cc of air in it.

In a case of rupture it would either be due to the above - someone injecting too much air into the balloon. OR incorrect placment of the swan. If they are in the right place and its teh right amount of air for the right amount of time, then they are safe.

[millkay]

Just my 2 cents worth, but I was taught to always detach the balloon and let all the air out, then replace it to keep it from inadvernently being wedged from turning, etc.

It is a scarey thing to have to wonder if the balloon was left full by the previous nurse, but you shouldn't have to. That would infer extreme carelessness on their part. That's where good communication skills come in, and both nurses doing a quick assessment at the bedside before letting the previous nurse go home.

There's always a chance for trouble with a swan line; however, you would expect astute nurses to be in charge of them. I've heard it done both ways, but I choose to do it the way I was taught. Like I said, just my 2 cents worth.

[burn out]

Swan-Ganz catheters are invassive instruments and are among our more advanced tools used in ICU, usually there placement is determined to be more of a benefit for the patient with all risks considered.All the tools we use in a hospital carry risks, a foley cath carries the risk of infection that can lead to death, the biggest risk for pain med is resp depression. I am sorry for the patients that have suffered from complications of these lines but the number of patients they have helped I am sure far out number the ones the have they have hurt ...if used properly.