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Swan-Ganz - right heart catheterization

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Definition

Swan-Ganz catheterization is the passing of a thin tube (catheter) into the right side of the heart and the arteries leading to the lungs to monitor the heart's function and blood flow, usually in persons who are very ill.

Swan Ganz catheterization

Alternative Names

Right heart catheterization; Catheterization - right heart

How the test is performed

The test can be done while you are in bed in an intensive care unit (ICU) of a hospital or in special procedure areas such as a cardiac catheterization laboratory.

Before the test starts, you may be given a mild sedative to help you relax.

You will lie on a padded table. Your doctor will make a small surgical cut near the groin or in your neck. A flexible tube (catheter, or “sheath”) is placed through the opening, into a vein. Sometimes it will be placed in your arm or wrist. You will be awake during the procedure.

A larger catheter is inserted and carefully moved into the upper chamber of the right side of the heart. X-ray images may be used to help the doctor see where the catheter should be placed.

Blood may be removed from the catheter to measure the amount of oxygen in the blood.

During the procedure, your heart's rhythm will be constantly watched using an electrocardiogram (ECG).

Cardiac catheterization

How to prepare for the test

You should not eat or drink anything for 8 hours before the test starts. You may need to stay in the hospital the night before the test. Otherwise, you will check in to the hospital the morning of the test.

In critically ill patients, the test may be done in the intensive care unit.

You will wear a hospital gown. You must sign a consent form before the test. Your health care provider will explain the procedure and its risks.

How the test will feel

You may be given sedation to help you relax before the procedure, but you will be awake and able to follow instructions during the test.

You may feel some discomfort when the IV is placed into your arm and some pressure at the site when the catheter is inserted. In critically ill patients, the catheter may stay in place for several days.

You may feel discomfort when the area of the vein is numbed with anesthetic.

Why the test is performed

The procedure is done to evaluate how the blood moves (circulates) in people who have:

  • Abnormal pressures in the heart arteries
  • Burns
  • Congenital heart disease
  • Heart failure
  • Kidney disease
  • Leaky heart valves (valvular regurgitation)
  • Shock

It may also be done to monitor for complications of heart attack and to see how well certain heart medications are working.

Swan-Ganz catheterization can also be used to detect abnormal blood flow between two usually unconnected areas.

Conditions that can also be diagnosed or evaluated with Swan-Ganz catheterization include:

  • Cardiac tamponade
  • Pulmonary hypertension
  • Restrictive cardiomyopathy

Cardiac catheterization - indications

Normal Values

  • Cardiac index is 2.8 to 4.2 liters per minute per square meter (of body surface area)
  • Pulmonary artery systolic pressure is 17 to 32 millimeters of mercury (mmHg)
  • Pulmonary artery mean pressure is 9 to 19 mmHg
  • Pulmonary diastolic pressure is 4 to 13 mmHg
  • Pulmonary capillary wedge pressure is 4 to 12 mmHg
  • Right atrial pressure is 0 to 7 mmHg

What abnormal results mean

Abnormal results may be due to:

  • Blood flow problems such as heart failure or shock
  • Heart valve disease
  • Lung disease
  • Structural problems with the heart such as a septal defect

What the risks are

Risks of the procedure include:

  • Bruising around the area where the catheter was inserted
  • Injury to the vein
  • Puncture to the lung if the neck or chest veins are used, causing lung collapse (pneumothorax)

Very rare complications include:

  • Cardiac arrhythmias requiring treatment
  • Cardiac tamponade
  • Embolism caused by blood clots at the tip of the catheter
  • Infection
  • Low blood pressure

References

Davidson CJ, Bonow RO. Cardiac catheterization. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, Pa: Saunders; 2011:chap 20.

Kern M. Catheterization and angiography. In: Goldman L,Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 55.

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