5 minutes Swan Ganz review

Hello everyone. I was rounding during shift last night and came across a patient with a Pulmonary artery catheter and I though a quick review would be helpful since we seldom use it now. Click here for a more in depth review of the Swan Ganz.

Insertion site:

Central vein, such as the femoral, jugular, antecubital or brachial vein. Can be done under fluoroscopy or ultrasound and echocardiography.

Flow and ECG waveform:

Central vein > SVC, IVC, > RA > tricuspid > RV > RVOT > pulmonary valve > PA (25/10 mmHg) balloon for PCWP or PAOP (4-12 mmHg, determine the cause of pulmonary hypertension, gives indirect assessment of left filling pressure), Sv02 draw ( >70%, determine cause of shock, cardiogenic, septic or distributive)  > CO (4-8 L/min), 

Hemodynamic parameters:

Indication:

• Evaluation for Pulmonary Hypertension
• mixed venous oxygen saturation (SvO2) measurement such as in septic or cardiogenic shock
• volume status in severe shock
• cardiac tamponade or constrictive pericarditis
• right-sided valvular disease, congenital heart disease, cardiac shunts for surgical repair

Contraindication:

• Active infection to insertion site
• Right sided ventricular assist device
• Lack of consent

PAC diagram:

Quadruple-lumen, thermodilution sensor attached to a pressure transducer, 60 to 110 cm length, 4F to 8F in caliber, 

• Blue, CVP, 30 cm from the tip, RA, RAP, for infusion
• White, 31 cm, RA, infusion
• Yellow, PA distal, PAP, mixed venous gas can be drawn from here
• Red/white, Thermistor, temperature-sensitive wire, 4 cm proximal to the tip of the catheter, The terminal portion-  thermistor bead rests in a main pulmonary artery
• Red, Balloon port, 
• Black lines, within catheter, one thin line- 10cm, thick line 50 cm

Complications:

• Infection
• Pneumo or hemothorax (subclavian approach)
• Air emboli
• Atrial, ventricular arrhythmias
• Valve rupture or wall perforation
• Misplacement
• Vessel rupture (balloon inflation), pseudoaneurysm formation, 
• Pulmonary infarction
• Thromboembolism secondary to inflammation or infection

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