Swan Lines

Specialties CRNA

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Ok, I just posted a separate message but I thought I would put this one under another title. I work in a MICU right now and do not see many Swan lines at all. How much of a disadvantage will this be to me in the application process? I have had classes to study the wave forms, etc, but I know that this is nothing like working with them on a daily basis. Do you think that admissions committees will eliminate me based on this fact, and if I do get into a school one day will I be at an enormous disadvantage? I am already anxious.

Thanks a lot.

I work in a MICU/CCU in Pennsylvania that still uses a lot of Swans/ CCO Swans. However, it does seem definitely that the trend is to move away from them. Nurses shouldn't hesitate to apply to CRNA school due to limited exposure.

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Specializes in MICU.
You can tell a whole lot about a patient from just the basic V/S, cvp, foley bag and a good assessment.

THAT IS ALL I'M SAYING !!!

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Hi all, CRNA of 4 yrs now. I came from a PICU background. Never saw a swan in my life. Played with 2 briefly during my anesthesia rotation. Sat in about 5 heart cases in the last 5 yrs. Don't do hearts myself. Don't use swans in any other types of cases period. Indeed they are a rapidly disappearing phenomenon. The risk of putting them in is higher than the benefits of having one. Those same benefits can be realized with a CVL. So I am a practicing CRNA with NO experience with swanz. Not worried about it either myself. If I need to, I will get OTJ training. Good luck all and don't worry about the interviews. Just be honest. Any if any of those programs hold crap like that over you, they are just weeding people out b/c they have too many over qualified applicants. I would apply to 2-3 other schools and go to the ones that accept you. You are ready and good luck. don't listen to any of the nay sayers, even if it's coming from a few stuck up NA schools. I had 2 of these stupid schools tell me I wasn't ready b/c of my PICU experience, just cuz they wanted adult ICU. Phuck em..bastages made me feel bad about myself for a little while. I did great in school and doing great now. Just like eating watermelon. You gotta know when to spit out the seeds.

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Specializes in I know stuff ;).

Well said Tran

I guess thats why the organizations suggest "Acute Care" as opposed to a year in ICU. The schools are the ones who enforce a non-existant standard. I know a few ER only people who got through CRNA school and did fine.

Hi all, CRNA of 4 yrs now. I came from a PICU background. Never saw a swan in my life. Played with 2 briefly during my anesthesia rotation. Sat in about 5 heart cases in the last 5 yrs. Don't do hearts myself. Don't use swans in any other types of cases period. Indeed they are a rapidly disappearing phenomenon. The risk of putting them in is higher than the benefits of having one. Those same benefits can be realized with a CVL. So I am a practicing CRNA with NO experience with swanz. Not worried about it either myself. If I need to, I will get OTJ training. Good luck all and don't worry about the interviews. Just be honest. Any if any of those programs hold crap like that over you, they are just weeding people out b/c they have too many over qualified applicants. I would apply to 2-3 other schools and go to the ones that accept you. You are ready and good luck. don't listen to any of the nay sayers, even if it's coming from a few stuck up NA schools. I had 2 of these stupid schools tell me I wasn't ready b/c of my PICU experience, just cuz they wanted adult ICU. Phuck em..bastages made me feel bad about myself for a little while. I did great in school and doing great now. Just like eating watermelon. You gotta know when to spit out the seeds.
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I must be working in a backwater hospital. We put PA caths in ALL hearts and thoracic or AAAs. I would reccomend being familiar with waveforms, complications. instertions as the board questions may certainly cover them. Also, if you do clinicals where they are used, you'll be expected to be used to them. You certainly will be expected to place, manage and interpert them when you train our heart or vascular rooms. Our students place up to 8 per week. BTW, quickly decide for me whether to start Levo or epi in the patient coming off pump who is hypotensive. SVR problem or CO issue? You decide without a cardiac output. It is easy to blow them off when you don't use them frequently.

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Specializes in I know stuff ;).

Hey W!

Well, that might be helpful but then i have managed without them as well.

Just out of interest i did a quick literature search. Seems that the overall position is the risk vs benefit isnt really worth it.

Over ~70% of the articles I looked at suggested increased mortality and complications in swan use. Also, seems that many researchers are now saying that trials done with and without PA guided tx show no difference in mortality rates ergo: dont need one.

I remember a time when every ICU pt had a swan. Like eveything, evidence often comes after implementation of cool toys. Seems the evidence isnt very strong for swans hence the changing of the guard.

I must be working in a backwater hospital. We put PA caths in ALL hearts and thoracic or AAAs. I would reccomend being familiar with waveforms, complications. instertions as the board questions may certainly cover them. Also, if you do clinicals where they are used, you'll be expected to be used to them. You certainly will be expected to place, manage and interpert them when you train our heart or vascular rooms. Our students place up to 8 per week. BTW, quickly decide for me whether to start Levo or epi in the patient coming off pump who is hypotensive. SVR problem or CO issue? You decide without a cardiac output. It is easy to blow them off when you don't use them frequently.
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Hey W!

Well, that might be helpful but then i have managed without them as well.

.

Well managing a patient in the ICU or during transport is different than managing a patient with PHT after a 4 hr pump run or even a 60 min run and the patient suddenly tanks as the surgeon closes the pericardium. I have to know SVR/CO now. not 2 min from now, now! I also maintain, it is not the trend you need to worry about, it is the practice at the hospital you are training at as well as what the school thinks is important. Whe i ask you in the OR about waveforms and you tell me that the trend is not to place them any longer, we'll have trouble.

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Specializes in I know stuff ;).

totally

Well said!

Well managing a patient in the ICU or during transport is different than managing a patient with PHT after a 4 hr pump run or even a 60 min run and the patient suddenly tanks as the surgeon closes the pericardium. I have to know SVR/CO now. not 2 min from now, now! I also maintain, it is not the trend you need to worry about, it is the practice at the hospital you are training at as well as what the school thinks is important. Whe i ask you in the OR about waveforms and you tell me that the trend is not to place them any longer, we'll have trouble.
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Specializes in ICUs, Tele, etc..

Don't mean to hijack this thread, but here's a link, I believe he's a cardiologist. It's a video where he breaks down the pros and cons about swan lines, it's an interesting talk... http://www.edwards.com/Products/PACatheters/VGRPinskyArchive.htm

DISCLAIMER: The talk is presented and came from a Swan Lines Company, so there might be a slight conflict of interest;) Either way it's a good talk. Oh and it runs only on Internet Explorer and not Mozilla...If anyone's interested on what he has to say.

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Swans in MICU and other units are probably totally uneccesary save for pronounced shock patients. In CVICU its a different ballgame. The literature doesn't necessarily say swans are bad as much as just a CVP is sufficient in a generally healthy patiens with satisfactory EF and few comorbidities. I would agree with that statement, but Swans have their place in junky hearts or extenuating circumstances. They just give you information that a CVP alone can't. Now with the advent of Litcos things may change.

Much of it is surgeon's preference as well. At 2 centers I've worked at every open heart patient gets a swan, no matter what. Yet another has probably the best CT surgeon in the nation if not the world and he only uses swans on very sick hearts, yet every patient stays in the unit the night before on a balloon. I'm just a nurse but to me if you're gonna put them on a balloon for 18 hrs preoperatively then how much worse is a swan?

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wntrMute2 is absolutely right. It does not matter what you think of the practice you need to know how to interpret the swan readings and how to treat those readings. We are currently averaging 20-25 hearts a week. When our students come here they are expected to know how to interpret the swan waveforms. I have done some hearts w/out a swan and they did just fine, but in the really sick pts I like having a swan. However, that is not to say that you should not apply to NA school because you do not have the experience. When I was in NA school we were thoroughly quizzed on hemodynamic monitoring in the CV class as well as in the OR during my heart rotation. There were a couple of students in my class who had little swan experience. They admitted to struggling a little with this aspect of the CV class, but with some extra studying they did fine.

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i agree w/ London88 - although not being overtly familiar with them should not bar you from interviewing - a little reading will go a long way in helping you understand and interpret them for interview purposes... however - just saying "they are going by the wayside" isn't something you ever want to say..it is like saying "they haven't taught me that yet...." big no no - teach yourself...

it is kind of like knowing how to manage an MH patient - hardly ever happens - but you better know your stuff for when it does...

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