Why use a Swan-Ganz Catheter?

Good morning class,
Most of the subjects that we have spoken about have to do with special equipment used in the ICU setting, so today we will talk about Swan-Ganz catheters. There are so many different things that can be used in the ICU and they can be very intimidating at first, so nurses have to become familiar with this equipment in order to properly manage the equipment and manage the critically-ill patient.
This is how the swan-ganz catheter looks like when it is in place:

(Dugdale, D. C. & Chen, M. A. 2010)

Why use a Swan-Ganz catheter?
Indications:
-used to monitor the heart's function and blood flow
Complications:
- Bruising around the insertion site
- puncture to the lung
- injury to the vein being catheterized
- cardiac arrythmias
- cardiac tamponade
- embolism
- infection
- low blood pressure
Abnormal results may indicate:
- valve disease
- lung disease
- heart failure or shock
Nursing Care:
- monitor patient for complications
- monitor for signs and symptoms of infection
- monitor hemodynamic parameters and document findings
- notify doctor of any abnormal parameters or findings

                                                    Photo of Swan-Ganz Catheter

So class, when taking care of a patient with a Swan-Ganz catheter it is important to remember that they are usually used in very ill patients which means that any changes in parameters can indicate changes in the patient's status. Nurses play an important role in the care of critically-ill patients because they spend the most time with the patient and are able to tell when changes in the patient are ocurring.
I hope this helped to understand some important points about Swan-Ganz catheters.

Interesting Link:
http://ht.edwards.com/resourcegallery/products/swanganz/pdfs/invasivehdmphysprincbook.pdf


                                                                      References
Dugdale, D. C. & Chen, M. A. (2010). Swan Ganz catheteriazation. Medline Plus. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/imagepages/18087.htm

Intra-Aortic Balloon Pumps

Hello class, Here we are again and I wanted to give you a little information about intra-aortic balloon pumps (IABP). Patients with IABPs are at risk for many complications and must be monitored closely. These patients are generally in a CCU or CTICU, where the care is more geared toward cardiac care, but depending on where you work, other ICUs might have them also. Here is a power point presentation and I hope you enjoy it.

Intra aortic balloon pumps

View more PowerPoint from fprrn123

Caring for a patient with a chest tube

Hello class,
Todays lesson will focus on the care of a patient with a chest tube. Some people find chest tubes a little intimidating, but they are not that scary and are not too difficult to maintain. I was going to make a power point out to teach this class, but I found a video that is 30 minutes long but it is very interesting and includes very important points. I suggest you take notes as you watch so that you have something for future reference, especially our final exam. Let me know what you think about the video and if you think it was too long.

Arterial Blood Pressure Monitoring

                                                          Arterial blood pressure set-up

                                          What an arterial waveform should look like.

                                               Patient with arterial line to radial artery

Hello class,
Today we will discuss arterial blood pressure monitoring. There are many different hemodynamic monitoring tools that are used in the intensive care unit (ICU), and one of the pieces of equipment that every ICU nurse must be familiar with is an arterial blood pressure line. Arterial blood pressure (ABP) is a hemodynamic index that guides the clinician to provide therapeutic interventions in critically ill patients (Mcghee & Bridges, 2002).
There are a few very important uses for an arterial line including:
   1- Blood pressure monitoring
   2- Arterial blood sampling
   3- Multiple blood draws
Nursing responsibilities inlude:
   1- Maintaining patency: The nurse sets up the line, zeroes the line, and levels it to patient's midaxillary line.
   2- Monitoing B/P and compare with manual B/P.
   3- Ensure waveform is appropriate and displayed on the monitor.
   4- Maintains alarm limits and ensures that they are audible.
   5- Monitors arterial site and maintains dressing.
   6- Documents appropriately.
When caring for a patient with an arterial line, it is important to listen for alarms, monitor for signs and symptoms of infection, and report any adverse signs to the doctor. When assisting the doctor with insertion, it is important to maintain sterility and have all equipment readily available. Having an arterial line is very beneficial but as soon as it is no longer needed, it should be removed in order to prevent infection.
If anyone has any questions, post them and I will answer as soon as possible.
Thank you class and see you soon.

Frances

                                                                    References
Critical care trauma centre. (2010). London Health Sciences Centre. Retrieved from http://www.lhsc.on.ca/Health_Professionals/CCTC/standards/artline.htm

Mcghee, B. H. & Bridges, E. J. (2002). Monitoring arterial blood pressure: What you may not know. Critical Care Nurse. Retrieved from http://ccn.aacnjournals.org/content/22/2/60.full.pdf+html

Death and Dying: How do you feel about this issue?

Hi class,
Working in an ICU setting unfortunately means that there will be times when issues of death and dying will occur. How do you feel about death and dying? Will you be able to handle the death of a patient that you have been caring for and thought they would be OK? What will you do when you don't agree with the wishes of the patient or family member/s regarding death related decisions?
End-of-life decisions may have been made by the patient, in which time, those decisions must be respected or there might be a situation where this subject was never brought up before by the patient or family. When a family member or representative must become the primary decision maker for the patient that cannot make their own decision, they often become the spokesperson for the family and consult with family members when it comes to complex decisions (Quinn, Schmitt, Baggs, Norton, Dombeck, & Sellers, 2012). Whatever the situation, discussing end-of-life care decisions is not easy but it can improve the quality of life of the patient and relieve some of the emotional burden on the family that is left behind (Zeytinoglu, 2011).
End-of-life care decisions might have never been discussed by the critically ill patient because the illness might have been sudden and unexpected, which makes it even harder making the right decision. It is sometimes difficult to understand the decisions that a patient or family member makes regarding end-of-life care, but nurses have the obligation to respect these decisions and not impose their opinions or disappointment regarding these decisions. Sometimes nurse have to take a step back and realize that patients and family members have to make these decisions on their own without pressure or influence from the outside. So as hard as it might be to keep our opinions to ourselves, we have to keep it to ourselves and be as supportive as we can and provide the best care possible.
So have you ever thought about end-of-life care? Don't be afraid to speak about it with family and friends. We don't like to think about these issues but it can make a big difference in how we spend the end of our lives.

Speak to you soon in the next class.

"Live as if you were to die tomorrow. Learn as if you were to live forever.”

(quote by Mahatma Gandhi)

References

Quinn, J. R., Schmitt, M., Baggs, J. G., Norton, S. A., Dombeck, M. T., & Sellers, C. R. (2012). Family members’ informal roles in end-of-life decision making in adult intensive care units. American Journal of Critical Care, 21, 1, 43-58.

Zeytinoglu, M. (2011). Talking it out: Helping our patients live better while dying. Annals of Internal Medicine, 154, 12, 830-832. Retrieved from http://libsys.uah.edu/kaplan/

Things we need to know about ventilators.

Hello class, The last time we met, we spoke about care of the patient that is being mechanically ventilated. Today, I will post some videos that will explain modes of ventilation, SIMV vs. AC, and PEEP. These videos are all about 10 minutes each and I hope you don't get bored because they are very informative. Let me know what you think. See you again in the next class.

Hello Class

The Ventilated Patient

Hello class,
Today I will discuss some important factors to consider when caring for a patient on a ventilator. Nurses are responsible for assessing, planning, and delivering care to the patient and must be able to provide basic nursing care as well as manage life-saving equipment.
I put together a powerpoint presentation to guide this lesson. Hope it helps and let me know if you have any questions. We will go into more detail in future lessons.

References
Nursing care of the ventilated patient. (2003). Western Sydney Health. Retrieved from http://intensivecare.hsnet.nsw.gov.au/five/doc/nurse_care_V_swahs.pdf

M510 the ventilated patient

View more PowerPoint from fprrn123

The first thing they see in ICU

The first thing I wanted to talk about pertaining to the critical patient, is their arrival in the ICU. It is bad enough that the patient has to be in ICU, but it is even worse when they are treated like an object. There are many ways that we as staff members do this, such as:
1. We start hooking them up to the monitors and IVs and pull them onto the ICU bed, without any warning.
2. We don't call them by their name, because we probably haven't checked it yet or we are just helping the nurse who will care for the patient.
3. We talk above them and about them, but never to them.
This is very unfair to the patient, who is now going to be poked and prodded and told what to do and when to do it. But we can change our attitudes and think of our patient as an actual person, with feelings and worries.
We can easily call them by their rightful name, tell them what we are doing before we do it, ask them if we can uncover their naked body before we do it, and provide them with the privacy they deserve, as we would like for ourselves.
I just wanted to start with this because as simple as it sounds, it is often forgotten because the ICU is a very crazy place at times and we have to do what is best for the patient.

Thank you for reading my opening lesson.
Frances

Becoming a critical care nurse.

Becoming a critical care nurse is not something to take lightly. Critical care nurses work hard and although they might only have 1-3 patients, they have a lot of responsibilities. One patient can have the nurse running all day or night, without even a minute to use the bathroom. But critical care nurses love what they do and they do it with pride and never expect anything back. Once in a while they get rewarded with a sign of respect from one of the doctors or maybe a thank you note from the patient or family member. That is more than enough sometimes to make it all worth the hard work.
On this blog, we will begin to have learning opportunities for those nurses that want to become critical care nurses or are new critical care nurses.
Hope everything enjoys and participates.
ccrn nurse