Tom Sharon
The most significant hazards with heart flow monitors


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Heart Flow Monitors

The most commonly used set of tubes for heart flow monitoring is the Swan-Ganz catheter. This device also allows for monitoring the blood pressure in the pulmonary artery and measuring the pumping effectiveness of the heart (cardiac output). This device goes into one of the main veins leading into the heart (superior or inferior vena cava) through the neck or under the collarbone (clavicle).

After the procedure, a chest x-ray is always required to make sure that the catheter is in the right place. Following that, the most significant hazards are fluid overload and infection. The risk of fluid overload is due to the fact that with the Swan-Ganz there is a central intravenous line in addition to whatever other IV lines the doctors and nurses have established. When there are three or four IVs, the nurses have to monitor the infusions carefully to prevent overload. This is especially dangerous if the patient has congestive heart failure, because the additional fluid can back up into the lungs and cause internal drowning.
The possibility of infection looms large because there is a foreign body - the tube - connecting the outside world to the sterile heart chambers. This tube penetrates all protective barriers against invading microorganisms. Thus the nurses have to maintain a sterile dressing over the insertion site and clean the area daily using a sterile technique. They must also maintain sterility whenever they open or penetrate the system. Understanding that they cannot always prevent infection despite best efforts, the nurses' response to the signs and symptoms of catheter contamination is critical. The strongest signs would be fever and chills. Redness at the insertion site is also a cause for concern. If you see any of these signs, be sure the nurses are aware of them and that they immediately contact the on-call physician for medical orders. The physician should respond by ordering blood, urine, and sputum cultures. If the doctor determines that the catheter is the source of infection, he or she must remove it, insert a new one (if it is still medically necessary), and order one or more intravenous antibiotics in accordance with the culture and sensitivity report (the report must show that the bug is not resistant to the antibiotic).

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