Swan questions

We use a heparinized flush system unless the platelets are dropping then we switch to saline- which is not in our policy but our physicians always order no heparin when the platelets continually drop...

Our Swans are used primarily on our cardiac surgery patients (though we also use them on other patient's when the need arises). Our cardiac surgery orders state Q4 numbers...if the patient is doing fine and the dr. wanted the swan left in for some reason, then they usually get done about twice a shift..of course we can obtain numbers more frequently as necessary...truthfully, even though I just read the policy the other day with my student, I can't remember exactly what it states...but I am thinking that it is Q4...I will check and get back to you...

We wedge only with physician order. Depending, sometimes that will be q shift or twice a shift, perhaps q 4 or q 8 hours. All depends on physician preference.

Saline for the pressure line.

Linda

I have a few question to ask about swan standards in your ICU's. In the ICU that I work we are considering a few changes in our policies.

When you have a swaned patient how frequent do you obtain a wedge when the patient is stable?

Do you use saline or heparinized saline for the flush system with your pressure line?

Any input would would be appreciated.

Thanks,

Karen

We also only wedge on an order, which is very, very rare where I work. We use a heparinized flush system.

We of course only wedge per doctor's orders, but typically for a stable pt we wedge Q8hrs (and of course if they're really that stable we d/c wedges or d/c the swan all together if we're not infusing anything through the proximal port). As far as a pressurized line for the swan we only use saline due to the possibility of heparin induced thrombocytopenia (apparently using just plain old saline is just as effective as a heparin solution).

At my hospital, we use NS for pressure lines. Like someone mentioned, NS seems to work just as well as heparinized saline.

We only wedge with an order.

Hillary

I have a few question to ask about swan standards in your ICU's. In the ICU that I work we are considering a few changes in our policies.

When you have a swaned patient how frequent do you obtain a wedge when the patient is stable?

Do you use saline or heparinized saline for the flush system with your pressure line?

Any input would would be appreciated.

Thanks,

Karen

Karen--

I work in a large ICU in Indianapolis, IN and this is what we do:

Wedge-As ordered, or every 8 hrs.

Saline--If the pt. has overly high PT/INR or if on Xigris

Heparin--All other pts.

If the Swan has been in for more than 1-2 wks, the need is re-evaluated and the line may be pulled.

We wedge on stable pts q 4 hrs and use heparinized saline.

We wedge on stable pts q 4 hrs and use heparinized saline.

Any risks associated with frequent wedges?

We never wedge in our institution and we use only saline for pressure lines.

we wedge in all ICUs except CTICU. And the patients initially have a heparinized solution if they coem from the OR, and when we do tubing changes, we replace it with saline.

You can blow the PA.

Any risks associated with frequent wedges?

we use only nss. evidence has proven that there is no difference with maintaining line patency & by using nss, you can prevent life threatening hit. heparin induced thrombocytopenia has been shown to occur even with 1 exposure to heparin & occurs more frequently than you might expect. i have seen patients with hit & it's a nightmare!

as far as wedging the swan, we usually get 1 or 2 readings & if they are within 1 or 2 mmhg of the pad, we use that. the balloons on the swans are only good for about 20 or so wedges & this way you reduce the change of pulmonary infarction or other complications.

sorry, i was so long winded!