Comments on: The Swann http://gruntdoc.com/2009/11/the-swann.html Ramblings of an Emergency Physician in Texas Wed, 17 Mar 2010 21:18:45 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: doc Russia http://gruntdoc.com/2009/11/the-swann.html/comment-page-1#comment-20122 doc Russia Sun, 15 Nov 2009 03:37:18 +0000 http://gruntdoc.com/?p=4110#comment-20122 I distinctly recall a senior surgical resident expounding the utility of the swan. Floated one in a patient of mine in the SICU when I was rotating on her service. Patient also had pericardial tamponade. Urine output dropped off, and my inclination was to give more fluids. Still, the senior had ridden my ass about stuff, so I decided to call her and tell her my intended course so that she couldn't come back after the fact and bitch about it after the fact. She asked for the swan numbers. I told them to her. She then started to go off on how *obviously* the patient had plenty of fluid on board, and needed lasix, not more fluids to increase their urine output. *blink* So I asked her how the pericardial tamponade affected the swan numbers. She said she would get back to me. I pushed fluids. Patient improved. I told you that story so I could tell you this: It is the swan song of the swan-ganz right now. If you want access, throw in a few EZ-IO lines, and back them up with a couple of cortices. I foresee even CVP measurement from the IJ or subclavian going away in the ED. We mostly use it for septic patients, and the few studies I have seen on comparative IJ vs. femoral CVPs have shown a relatively high degree of concurrence. At least in the ED, I do not see a future for the Swan-Ganz at all. I distinctly recall a senior surgical resident expounding the utility of the swan. Floated one in a patient of mine in the SICU when I was rotating on her service. Patient also had pericardial tamponade. Urine output dropped off, and my inclination was to give more fluids. Still, the senior had ridden my ass about stuff, so I decided to call her and tell her my intended course so that she couldn’t come back after the fact and bitch about it after the fact. She asked for the swan numbers. I told them to her. She then started to go off on how *obviously* the patient had plenty of fluid on board, and needed lasix, not more fluids to increase their urine output.
*blink*
So I asked her how the pericardial tamponade affected the swan numbers. She said she would get back to me.
I pushed fluids. Patient improved.

I told you that story so I could tell you this:
It is the swan song of the swan-ganz right now.
If you want access, throw in a few EZ-IO lines, and back them up with a couple of cortices.
I foresee even CVP measurement from the IJ or subclavian going away in the ED. We mostly use it for septic patients, and the few studies I have seen on comparative IJ vs. femoral CVPs have shown a relatively high degree of concurrence.

At least in the ED, I do not see a future for the Swan-Ganz at all.

]]> By: TheNewGuy http://gruntdoc.com/2009/11/the-swann.html/comment-page-1#comment-20120 TheNewGuy Sun, 15 Nov 2009 00:52:58 +0000 http://gruntdoc.com/?p=4110#comment-20120 TxTechMSIII: The 8.5F sheath/introducer that comes with the Swan is a great resuscitation tool. You can cram blood and fluids into somebody at an unbelievable rate with those things. TxTechMSIII: The 8.5F sheath/introducer that comes with the Swan is a great resuscitation tool. You can cram blood and fluids into somebody at an unbelievable rate with those things.

]]> By: geena http://gruntdoc.com/2009/11/the-swann.html/comment-page-1#comment-20118 geena Sat, 14 Nov 2009 22:09:07 +0000 http://gruntdoc.com/?p=4110#comment-20118 Eh. When they can't figure out what else to do, they float a swan. Otherwise, it's used for cardiac outputs/indexes/svr after open heart surgery. And that extra fluid port is very handy. Eh. When they can’t figure out what else to do, they float a swan.

Otherwise, it’s used for cardiac outputs/indexes/svr after open heart surgery.

And that extra fluid port is very handy.

]]> By: TxTechMSIII http://gruntdoc.com/2009/11/the-swann.html/comment-page-1#comment-20114 TxTechMSIII Sat, 14 Nov 2009 17:43:51 +0000 http://gruntdoc.com/?p=4110#comment-20114 After just getting off of my surgery clerkship, i was told by one of the trauma guys that he had them keep around a bunch of the Swan introducer kits, just because in an acute setting it served as a very efficient large-bore delivery system for all sorts of fluid/fluid type products. But the catheter itself, he said they really didnt use anymore. After just getting off of my surgery clerkship, i was told by one of the trauma guys that he had them keep around a bunch of the Swan introducer kits, just because in an acute setting it served as a very efficient large-bore delivery system for all sorts of fluid/fluid type products. But the catheter itself, he said they really didnt use anymore.

]]> By: Halothane http://gruntdoc.com/2009/11/the-swann.html/comment-page-1#comment-20109 Halothane Sat, 14 Nov 2009 14:09:17 +0000 http://gruntdoc.com/?p=4110#comment-20109 Yep, still used frequently in surgical critical care, trauma critical care, and CV critical care.....a lot of it is regional but I'm seeing more of a move back to swan ganz cathethers vs. non-invasive methods in my area. All of that long hand math doesn't have to be done anymore :) The monitoring box will do all of that garbage. Yep, still used frequently in surgical critical care, trauma critical care, and CV critical care…..a lot of it is regional but I’m seeing more of a move back to swan ganz cathethers vs. non-invasive methods in my area. All of that long hand math doesn’t have to be done anymore :) The monitoring box will do all of that garbage.

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