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Swan-Ganz - right heart catheterization

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.

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 will be given a mild sedative to help you relax.

An area of your body, usually the neck or groin, is cleaned and numbed with a local anesthetic. The health care provider will make a small cut in a vein in your neck or groin. Sometimes, the cut is made in another area. A thin hollow tube called a catheter is inserted through the cut and up into a vein. It is carefully moved up into the right atrium (upper chamber) of the heart. X-ray images help the doctor see where the catheter should be placed.

The catheter is threaded through two heart valves (the tricuspid and pulmonary valve) and placed into the pulmonary (lung) artery. Once it is in place, the blood pressure in the pulmonary artery is measured.

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).

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.

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

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 indicate:

• Circulatory flow problems such as heart failure or shock
• Heart valve disease
• Lung disease

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

Special considerations

References

Faxon DP. Catheterization and angiography. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 56.