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Pulmonary artery catheter
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Pulmonary artery catheter
A pulmonary artery catheter (PAC), also known as a Swan-Ganz catheter, thermodilution catheter, or right heart catheter, is a balloon-tipped catheter that is inserted into a pulmonary artery in a procedure known as pulmonary artery catheterization or right heart catheterization. Pulmonary artery catheterization is a useful measure of the overall function of the heart particularly in those with complications from heart failure, heart attack, arrhythmias or pulmonary embolism. It is also a good measure for those needing intravenous fluid therapy, for instance post heart surgery, shock, and severe burns. The procedure can also be used to measure pressures in the heart chambers.
The pulmonary artery catheter allows direct, simultaneous measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure (pulmonary wedge pressure) of the left atrium. The pulmonary artery catheter is frequently referred to as a Swan-Ganz catheter, in honor of its inventors Jeremy Swan and William Ganz, from Cedars-Sinai Medical Center.
General indications are:
No study has definitively demonstrated improved outcome in critically ill patients managed with PA catheters. Given that the PA catheter is a monitoring tool and not a therapy in and of itself this is not entirely surprising. Justification for its continued use rests on a large body of clinical experience, disadvantages of other cardiac output monitoring systems, its ability to accurately measure pulmonary artery pressure, and the potential to use the catheter as a direct conduit for drug administration into the pulmonary artery.
The catheter is introduced through a large vein—often the internal jugular, subclavian, or femoral veins. Ease of placement for a pulmonary artery catheter from easiest to difficult is: right internal jugular > left subclavian > left internal jugular > right subclavian. From this entry site, it is threaded through the right atrium of the heart, the right ventricle, and subsequently into the pulmonary artery. The passage of the catheter may be monitored by dynamic pressure readings from the catheter tip or with the aid of fluoroscopy.
The standard pulmonary artery catheter has two lumens (Swan-Ganz) and is equipped with an inflatable balloon at the tip, which facilitates its placement into the pulmonary artery through the flow of blood. The balloon, when inflated, causes the catheter to "wedge" in a small pulmonary blood vessel. So wedged, the catheter can provide an indirect measurement of the pressure in the left atrium of the heart, showing a mean pressure, in addition to a, x, v, and y waves which have implications for status of the left atria and the mitral valve. Left ventricular end diastolic pressure (LVedp) is measured using a different procedure, with a catheter that has directly crossed the aortic valve and is well positioned in the left ventricle. LV edp reflects fluid status of the individual in addition to heart health. See also pulmonary wedge pressure and ventricular pressure.
The idea for a sail or balloon tip modification of Ronald Bradley's simple portex tubing method came about from Swan's observation from the Laguna Beach CA shore of sail boats on the water on a relatively calm day. Boats with conventional slot sails were still; one with a spinnaker was able to make reasonable headway. The concept of using thermodilution to measure cardiac output was originally the idea of Arnost Fronek. As a former colleague of Fronek, Ganz added the thermistor modification after Swan showed him the initial balloon design, which was fabricated by Edwards Laboratories, which had previously contracted with Swan as a consultant.
After Swan developed the initial balloon tip, Ganz used Fronek's idea and added a small thermistor (temperature probe) about 3 cm behind the tip. 10 ml of saline (0.9% NaCl) under 10 °C or room temperature (not as accurate) is injected into an opening in the right atrium. As this cooler fluid passes the tip thermistor, a very brief drop in the blood temperature is recorded. A recent variation in design is the incorporation of a heating coil on the catheter (30 cm from the tip, residing in the atrium area) which eliminates the cold fluid bolus, a major factor in human technique variation.
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Pulmonary artery catheter
A pulmonary artery catheter (PAC), also known as a Swan-Ganz catheter, thermodilution catheter, or right heart catheter, is a balloon-tipped catheter that is inserted into a pulmonary artery in a procedure known as pulmonary artery catheterization or right heart catheterization. Pulmonary artery catheterization is a useful measure of the overall function of the heart particularly in those with complications from heart failure, heart attack, arrhythmias or pulmonary embolism. It is also a good measure for those needing intravenous fluid therapy, for instance post heart surgery, shock, and severe burns. The procedure can also be used to measure pressures in the heart chambers.
The pulmonary artery catheter allows direct, simultaneous measurement of pressures in the right atrium, right ventricle, pulmonary artery, and the filling pressure (pulmonary wedge pressure) of the left atrium. The pulmonary artery catheter is frequently referred to as a Swan-Ganz catheter, in honor of its inventors Jeremy Swan and William Ganz, from Cedars-Sinai Medical Center.
General indications are:
No study has definitively demonstrated improved outcome in critically ill patients managed with PA catheters. Given that the PA catheter is a monitoring tool and not a therapy in and of itself this is not entirely surprising. Justification for its continued use rests on a large body of clinical experience, disadvantages of other cardiac output monitoring systems, its ability to accurately measure pulmonary artery pressure, and the potential to use the catheter as a direct conduit for drug administration into the pulmonary artery.
The catheter is introduced through a large vein—often the internal jugular, subclavian, or femoral veins. Ease of placement for a pulmonary artery catheter from easiest to difficult is: right internal jugular > left subclavian > left internal jugular > right subclavian. From this entry site, it is threaded through the right atrium of the heart, the right ventricle, and subsequently into the pulmonary artery. The passage of the catheter may be monitored by dynamic pressure readings from the catheter tip or with the aid of fluoroscopy.
The standard pulmonary artery catheter has two lumens (Swan-Ganz) and is equipped with an inflatable balloon at the tip, which facilitates its placement into the pulmonary artery through the flow of blood. The balloon, when inflated, causes the catheter to "wedge" in a small pulmonary blood vessel. So wedged, the catheter can provide an indirect measurement of the pressure in the left atrium of the heart, showing a mean pressure, in addition to a, x, v, and y waves which have implications for status of the left atria and the mitral valve. Left ventricular end diastolic pressure (LVedp) is measured using a different procedure, with a catheter that has directly crossed the aortic valve and is well positioned in the left ventricle. LV edp reflects fluid status of the individual in addition to heart health. See also pulmonary wedge pressure and ventricular pressure.
The idea for a sail or balloon tip modification of Ronald Bradley's simple portex tubing method came about from Swan's observation from the Laguna Beach CA shore of sail boats on the water on a relatively calm day. Boats with conventional slot sails were still; one with a spinnaker was able to make reasonable headway. The concept of using thermodilution to measure cardiac output was originally the idea of Arnost Fronek. As a former colleague of Fronek, Ganz added the thermistor modification after Swan showed him the initial balloon design, which was fabricated by Edwards Laboratories, which had previously contracted with Swan as a consultant.
After Swan developed the initial balloon tip, Ganz used Fronek's idea and added a small thermistor (temperature probe) about 3 cm behind the tip. 10 ml of saline (0.9% NaCl) under 10 °C or room temperature (not as accurate) is injected into an opening in the right atrium. As this cooler fluid passes the tip thermistor, a very brief drop in the blood temperature is recorded. A recent variation in design is the incorporation of a heating coil on the catheter (30 cm from the tip, residing in the atrium area) which eliminates the cold fluid bolus, a major factor in human technique variation.
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