Right-Heart Catheterization, Pulmonary Artery Catheterization
A doctor inserts a catheter into a vein in the arm, neck, or groin, and carefully threads it into the heart’s right atrium, through the tricuspid valve, into the right ventricle, and into the main pulmonary artery, which brings blood to the lungs. The catheter records blood circulation and fluid pressures in these areas. Pulmonary artery pressures can be used to indirectly assess function of the left ventricle—the heart’s main pumping chamber—and to measure cardiac output (the amount of blood pumped from the heart).
Purpose of the Swan-Ganz Catheterization
- To monitor patients for complications after a heart attack, such as cardiogenic shock or fluid in the lungs (pulmonary edema)
- To monitor blood volume and heart valve function in people who are in shock or who have another serious medical condition, such as burns, kidney disease, or pulmonary edema
- To evaluate the effects of certain cardiovascular medications, such as nitroprusside and dobutamine
- To monitor patients undergoing open heart surgery, particularly coronary artery bypass procedures
- To determine the cause of low blood pressure
- To help a doctor best determine treatment of high blood pressure
- To draw blood without having to repeatedly stick a needle into the patient with severe lung problem
- To diagnose or evaluate coronary artery disease, congenital heart defects and problems with the heart valves
- To diagnose causes of heart failure or cardiomyopathy
Who Performs It
- A cardiologist
- If the procedure is elective, it is performed in a hospital catheterization laboratory. In critically ill patients, it may be done in the intensive care unit.
- People who have a serious bleeding disorder or who are extremely agitated cannot undergo this procedure.
- The test cannot be performed in people with an abnormal heart rhythm (arrhythmia) called left bundle branch block because placement of the right-heart catheter may lead to complete heart block.
Before the Swan-Ganz Catheterization
- Do not eat or drink fluids for 6 to 8 hours before the test.
What You Experience
- Immediately before the test, an intravenous (IV) line is inserted into a vein in your arm. You may be given a mild sedative, but you will remain conscious throughout the procedure.
- You lie on your back on a padded table, and ECG leads are applied to monitor your heart rate and rhythm during the procedure.
- The area of catheter insertion (your arm, neck, or groin) is cleansed with an antiseptic to help prevent infection, and a local anesthetic is injected to numb the area.
- The doctor makes a small incision and inserts a catheter into the selected vein; you will feel pressure during insertion, but no other discomfort.
- The doctor then carefully threads the catheter to your heart. In many cases, fluoroscopy is used to watch its progress on a viewing monitor.
- The position of the catheter tip is verified by a chest x-ray and by monitoring devices that record pressures within the heart.
- Catheter insertion takes from 30 minutes to 1 hour. In critically ill patients, the catheter may remain in place for several days to allow continuous monitoring.
Risks and Complications
- Possible complications include arrhythmias; Cardiac tamponade; heart attack; stroke; blood clots; pulmonary embolism (blockage of a pulmonary artery); perforation of the pulmonary artery or heart wall; catheter-induced damage to the vein; infection or blood loss at the insertion site; bleeding; and low blood pressure. Emergency equipment is available at the catheterization lab.
After the Swan-Ganz Catheterization
- You will remain hospitalized for a few hours after the procedure (or longer if you are already hospitalized for another medical condition).
- Your blood pressure and other vital signs will be checked periodically, and the catheter insertion site will be monitored for any signs of infection, such as redness, swelling, or discharge.
- The doctor will review the test data for evidence of cardiac or circulatory abnormalities.
- If a definitive diagnosis can be made, appropriate therapy will be initiated, depending on the specific problem.
- In some cases, additional tests may be needed to further evaluate abnormal results.
The Johns Hopkins Consumer Guide to Medical Tests
Simeon Margolis, M.D., Ph.D., Medical Editor
Updated by Remedy Health Media