Transducer Placement?

[ClanMcBride]

I work in a smaller hospital with a 10 bed ICU. We actually see a lot of action because we have a very busy cath lab that uses balloon pumps and we also treat a lot of severe sepsis. So I am not new to CVP/ART lines. We always, always, tape our CVP transducers to the patient at the phleb. axis. No need for leveling, easy breezy.

I recently got a second job in an ICU/CCU and they literally think I am crazy, or stupid. None of the nurses have ever heard of such a thing so they tape their transducers to a pole and level it every 2 or 4 hours with the patient flat.

I understand that that way works also, but the whole point of an electronic transducer is to make things easier and more consistent. It seems to me that taping it to the patient eliminates leveling errors, as well as positioning errors. It also reduces irritation of the oropharynx due to movement of the ET tube, and reduces aspiration risk of patients with OG tubes and continuous feedings.

Is there something I am missing? Is there a reason that you would NOT tape the transducer to the patient? Thanks in advance!

M

[icuRNmaggie, BSN, RN]

I think it is far more accurate taped to the pt or to taped to a rolled up blue pad and placed at the phlebostatic axis rather than three feet away from the pt.

Only because I have seen and followed lazy nurses who move the transducer holder up and down the pole to make the ABP say what they want it to say.

[ausrnurse]

For tubed pts at my unit, we place them on an IV pole. Re-level after pressure area care. Moving/walking patients, I tape it to the patient.

[MowbrayRN]

In the CCU at my hospital we tape it to the pt, putting it on a poll leaves to much room for error and variability.

[MunoRN, RN]

I've never seen it taped as a long term method. My first concern would be that it's not very skin friendly. More importantly, it's not very accurate. I think many incorrectly believe that the phlebostatic axis is a single point on the lateral chest wall, even though it's not.

The purpose of the phlebostatic axis is to approximate the level of the right atrium. At the lateral chest wall, this point is only at the intersection of the 4th intercostal space and the mid-axillary line when the patient is flat on their back. That point on the lateral chest wall changes when the patient is on one side or the other, which as a general rule these patient should pretty much always be on one side or the other.

We draw a line (not an x) that goes straight down from chest to back at the level of the 4th intercostal space, and use a point halfway between the chest and mattress to level to, which changes constantly with turning.

[Biffbradford]

I think putting it on a pole is very 'old school'. You'll see that in old textbooks. Have never seen it done in practice.

[MunoRN, RN]

I think putting it on a pole is very 'old school'. You'll see that in old textbooks. Have never seen it done in practice.

Do you re-tape it every time you turn the patient?

[Biffbradford]

Dunno ... I'm not -that- old that I've ever done it myself.

But yes, you would have to re-zero it when you've repositioned the patient.

[tcvnurse, BSN, RN]

I use a piece of tape and a hemostat to clamp the transducer to the patient's gown at the phlebostatic axis. Done and done!

edited for clarity, and clamping to gowns, not patients!

[MunoRN, RN]

I'm curious how those who tape or clamp the transducer to the patient deal with turning a patient. Do you just not turn patients? Do you only read the CVP when they are flat on their back?

[Biffbradford]

I'm curious how those who tape or clamp the transducer to the patient deal with turning a patient. Do you just not turn patients? Do you only read the CVP when they are flat on their back?

If you want an accurate reading, then yes. If you suspect trouble they should be on their back anyway.