swan pacing

[OKRN]

I am not familiar with swan pacing, but I need to now if you do a pwp when you have a pt that is beng 100% paced. why or why not.

thanks!

[ZASHAGALKA, RN]

I am not familiar with swan pacing, but I need to now if you do a pwp when you have a pt that is beng 100% paced. why or why not.

thanks!

I can't think of why not and don't remember ever letting it stop me before although I must confess to not using swans for pacing much.

But you're pacing through a different lumen then the PAP lumen. And we wedge pt's with internal pacers . . . so why not transvenous swan pacers

(Using the cordis or the VIP port for the pacer, yes?)

~faith,

Timothy.

[papawjohn]

Hey OKRN

I assume your pt has a "pacing swan" so you have a 'transvenous pacer'. And you have a record of previous PAP readings. OK?

If your pt has been pacing for a long period of time--and you have markedly different wedge pressures and PADiastolic readings--then by ALL MEANS call the DR. Because you have an evolving situation of (for instance) slowed Heart Rate (to the Paced Rate) that has decreased the over-all cardiac output and therefore increased your Pts CHF.

If your pt has previously had an intrinsic rate ABOVE the pacer limits and suddenly now in pacing only---wake the pt up, and if the AWAKE Pt has heart rate, vital signs, PAPressures markedly different than the baseline. CALL THE CARDIOLOGIST.

There is no reason to expect that a 'good' paced rate will change the PAW or PAD from a 'good' waking/intrinsic/non-paced rate. If the paced rate gives 'numbers' that indicate worsing CHF--and you are the nite nurse who sees these paced numbers because the waking Pt has higher heart rate and 'better' numbers--then you need a faster paced rate.

If you dreamed this up in the middle of the night, go back to sleep.

Papaw John

[ZASHAGALKA, RN]

It was my understanding that you were asking if it would hurt to wedge for routine purposes/monitoring on a swan that was being simultaneously utilized as a transvenous pacer.

I didn't get that you were wedging for a specific concern - just as a routine measurement.

I couldn't think of a contraindication. Pacing itself isn't a contraindication to obtaining a PCWP and you are using separate lumens for pacing and wedging (Not to mention that both activities are taking place in completely different places).

But I suppose you could use the PAD - I'm just used to using the PAD as a backup if the PCWP was actually contraindicated, such as doesn't wedge...

Somebody might know a contraindication that I cannot think up at 4 am, but I was just giving my

~faith,

Timothy.