SWANS - Wedging

Rn's wedge if it is pt. appropriate.

We dont wedge in CVICU. They do it in the other units however. We use PAD which is close enough in a majority of the cases. We had an RN/Paramedic rupture the PA many years ago. They saved the patient after she intubated him and took him to emergent surgery in the middle of the night, however after that they decided that PAD was sufficient.

We have always done a wedge q8-12hr but only if there was a noted difference between the PAOP and the PAD.:redbeathe

We wedge Q4 after we shoot our COs.

I work in the SICU but we get CT post op pt and we don't wedge them a few years ago a RN wedged a pt and ruptured the PA so we don't do it in those pt but other post op pt with swans we do just depends on the pt.

we wedge about q 4-8hrs or if needed for crashing vitals. the doc's write how often they want us to inflate, typically its q4-8hrs depending on the pt.

Over the years, I have seen a few blown PA's. All died within hours. Still the hospital's never mandated that RN's not wedge. It's always a risk that every ICU nurse must understand that when they wedge, or even have a patient with a swan that an inadvertant wedge might happen and go unnoticed.

I witnessed my own wife, some 18 years ago wedge a post open heart PT on IABP and vent. Blood filled the ET tube and she become very unstable (she already was unstable). I tried to help my wife, she felt responsible yet did nothing wrong. The patients name was "Sally" and her husband name was "Harry". The husband said thier marriage was just like the movie.

We do proceedure all the time that have rick and complaicentcy is our biggest enemy.

I do right heart cath every few days, sometimes daily in the cath lab. I still am cautious when advancing or wedging a swan.... even watch the Cardiologist doing it! I always have SALLY in the back of my mind.

Another PA rupture was a CA mass on the bronchial tree. The man literally projected blood on my chest and died in my arms before I could lift him into bed for his chair. Oh the stories over 25 years!

On my unit our nurses wedge as long as no contraindications, and the frequency is based on the patients need for gaining a PAWP.

We have quite an extensive competancy pack to complete first though:)

I worked with 2 MDs of which one would have us wedge and the other would not.. Same RNs caring for their patients. Funny how you would not for one doctor's patients, but if the other was on call you ended up wedging on the patient anyway as the second wanted the numbers.

Unfortunately, PA ruptures can occur. It is one of the reasons to go slowly on inflating the balloon and immediately releasing at the first sign of an overwedge. Too often nurses push the air in and then look at the monitor. The entire process should be monitored carefully and appropriate actions should take place. Even with extensive experience and very safe practice it is still a risk associated with swan ganz

I work in a CTICU and we never wedge. Apparently there was an incident a few years ago where a pt was left wedged and died. It appears that any place that has had an incident doesn't wedge anymore.

When I started (mind you

We standing orders, DO NOT WEDGE on all PA Caths..