Swan- Pa question

[bectrek]

Hi everyone,

I just switched jobs. We were allowed to transfuse prbc & blood products through the PA port of a swan if no other access was available. I did that today at my new job & my charge nurse had a fit :)

Can anyone explain the rationale behind not using the PA for transfusions in emergent cases? I've done online searches & keep coming up with "you can't use the pa port for infusions" I'd like more specific info. I am very comfy with swans , just need to know this one bit of info

thanks so much in advance!

[iluvivt, BSN, RN]

It is my understanding it has to do with its tip location in a pulmonary artery branch. It does not seem wise to be administering directly into a pulmonary artery and this will most certainly will increase your risk of occlusion and potential damage to the vessel. Would it not be considered administering into the arterial system? The manufacturers of these catheters only recommend that the medication lumen that exits in the superior vena cava be used for medication administration and blood products and I certainly would follow their recommendation.

A better option is to secure another line such as a peripheral or if needed a PICC or CVC.

[bectrek]

Thanks for the reply.

They don't put in extra lines on the weekend at this hospital & a PIV wasn't possible (small community type place). I guess I am still confused because I have worked where direct infusion onto the PA was used limit stress on the left ventricle. However, it's my guess clotting & loss of waveform during infusion (so accidental wedge wouldn't be noticed) + your answer is the rationale?

I've just always been one of those people who needs to know the "why" for policy :)

[bectrek]

Um, er...dugh

I meant limit stress on right ventricle. Sorry :)

[ghillbert, MSN, NP]

Have you checked the manufacturer website? The instructions for use of the catheter has a lot of info.

[bruinlaura]

Was there a reason you couldn't use the cordis? We don't put blood in any of the ports in the swan but I use the cordis for blood and fluid boluses almost exclusively. We will use the medication port for drips and the proximal port for other meds but we never use the pa port for anything other than monitoring and svo2 sampling.

[joeyzstj, LPN]

Are you meaning the PA port or the VIP infusion port? We use the VIP port (infusion port) all the time. Ive never personally had to run anything through the PA line itself. In an emergency you can use pretty much anything you can find...........swan, sheath, Dialysis Cath, ect...

[seanpdent, ADN, BSN, MSN, APRN, NP]

Interesting... sounds like a 'facility' preference more than a product guideline. I too have done both.

And yep, emergent... we use whatever is needed/available.