• Tools in the Tool Bag

    by Klint Kloepping. Last modified: 13/06/15

     

    All of us have that one thing we always go to when we work.  No matter where you work or what you do, you have that one favorite device.  Every practitioner has that one tool they use all the time.  For years and years the one tool that has been used in the Intensive Care Unit has been advanced hemodynamic monitoring.  The use of such lines has diminished some in the Emergency Department and some in the transport environment.  However, there are always aggressive physicians out there that will place an ART line or a CVP line because it their go to device in shock or extremely sick patients.

    How does this affect us in the transport environment?  Whether a facility is monitoring a patient with an ART line, SWAN GANZ, or CVP line we need to be ready to care for these patients and understand the application to patient care and management.  This technology has been available and utilized in the ICU’s for years.  Let’s be honest the unit is a whole different world than the back of a critical care ground truck or an air ambulance.  Some would argue that monitoring these invasive lines in transport does not change treatment and it may actually take up time with packaging and preparation of the patient on scene.  Far be it for me to determine what others do in their service or practice, but I just want to leave a few points regarding these devices.

    Getting our hands on this equipment, practicing zeroing the transducer and doing a fast flush are just a piece of the puzzle.  During downtime looking at and reviewing waveforms and their meaning to the patient are other aspects of care that are vital in caring for these invasive lines.  The downside to utilizing invasive lines in transport is that a lot of different things could throw off the reading we see on the monitor.  Vibration, different pressures, movement of the patient without re-zeroing the transducer and transducer movement.  Make sure that transducer is secured to the chest wall at the level of the phlebostatic axis, fourth intercostal space mid axillary line.  Securing the transducer and zeroing the line can be troublesome in transport as well.  So, try to have these things complete prior to transport.

    Despite all of the reasons it may be non-beneficial to transport and utilize these invasive monitoring lines it is extremely important that we review and spend time with them.  There are a lot of different topics we spend a lot of our education on, but for some reason this gets missed a lot of times.  Now, is this the silver bullet and the deciding factor of your patient care and destination?  No, it is not going to dictate our care or where we take the patient.  What it does a good job of showing is real time blood pressures and an overall window into the world of our patient.  Remember that saying, treat the patient, not the machine?  Well, in this case it is still true.  We need to treat our patient not the machine.  It helps to be able to troubleshoot problems that may arise due to issues with equipment or erroneous readings.

    These lines are monitored frequently by some critical care programs, whether air or ground and others do not monitor them.  Regardless of what you do look at these as another tool to use to look at and assess patients.  It is up to us to use our powers of assessment and observation to make clinical decisions on our patient’s care.  They truly are just another tool in the tool box of things we have available to us in the transport world.  Review, Recite, and Repeat the process of using invasive hemodynamic monitoring lines in transport.  The use of such tools can be extremely useful and we have to be ready to utilize these tools.

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    Klint Kloepping

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