I don't have your experience, but couldn't arterial waveform analysis replace the need for PAC in the ICU. They give pretty similar data and many studies have shown their equivalency. Sure, there is limitations to the data provided with the A-line, but there are limitations to the data provided by the PAC as well.
Inotropes, not Ionotropes. Sorry one of my many pet peeves.
I wasn't argueing that SVV or arterial contour analysis is a great monitor. PAC isn't that great of a monitor either with errors found in a multitude of condition. E.g. PAOP is an indirect measurement of LVED volume and any diastolic dysfunction will lead to incorrect correlation.
i don't completely subscribe to this notion. Problems with PAC occur, as with any monitor, we people how are unfamiliar with the monitor try to use it. Inaccurate data also falls in this catagory. Many studies are performed is institutions with people less likely to use the monitor. But someone who has shed it for years and has the "n" to show for it can make great use out of something others feel are limited.
Their only clear indication nowadays is to monitor pulmonary arterial pressures, usually for pulmonary or right-sided heart pathology. Anything else, and it's a lot of speculation (there is a bunch of stuff between that balloon and the left ventricle, and even if it were in the LV, what do increased pressures mean?). They are not even good for following serial cardiac outputs, because their error margin is comparable with the 10-15% magnitude of change we use to look for response. A good echo machine and bedside echocardiographist (intensivist) will beat the Swan 9 times out of 10.
Only about 8% of ICU patients qualify for SVV. The Swan is useless for fluid challenge, too.
Tell your ICU that inotropes correlate with increased mortality in every recent study I have seen them in.
@PainDrain's answer is what you should remember, at this stage of your training. It's more important to know the limitations of the device, than what it's supposed to be used for.
wow, that's new! first time i've ever heard of someone doing a cardiac case without a central line.
I put them in if there is history of severe pulmonary hypertension or if the EF is very low because the surgeon and the ICU people want it. I don't really use it other than looking at the PA pressure. It leads to over treatment compared to just a central line either because the PA pressure is too high and someone wants milrinone or nitric oxide, or because the cardiac index is "low" and they want to make it over 2 regardless how the patient is doing. If it were up to me I would never put one in.
I serously doubt that.
This is a very good and important post. This is exactly what studies say. But it doesn't have to be a midline; any 2 inch-catheter, 20G or larger, in a big vein above the antecubital and popliteal folds (so they won't reverse the flow if it's obstructed by limb flexion), will do.
They would have to know the blood volume of the patient pretty accurately all through out the case for that to work. The guys ai work with are good, but that is a little too much.
