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Pulmonary Artery

Catheterization

Dr Sharafuddin Shah Bin Rhasbudin Shah


Unit Anestesiologi Kardiotorasik dan Perfusi,
Hospital Tengku Ampuan Afzan
History

Invented in 1970
frequently referred to as
aSwan-Ganz catheter, in
honor of its inventors
Jeremy SwanandWilliam
Ganz, from
Cedars-Sinai Medical Center
.
continuous cardiac output
monitoring
central temperature
monitoring
measurement of pulmonary
artery pressure (can also
measure RA and RV
pressures during insertion) USES
measurement of mixed
venous saturations
estimation of diastolic filling
of left heart (normal PCWP
2-12mmHg)
right ventricular failure
pulmonary hypertension
weaning failure of cardiac Indications
origin
post-cardiac surgery
Patients undergoing cardiac
surgery with
-Poor left ventricular
compliance(ejection fraction <40%) for cardiac
-RWMA
-Recent MI (<6 Months)
surgery, the
-LMS disease indications
-Valvular lesion (except tricuspid are:
and pulmonary stenosis)
-Presence of pulmonary artery
hypertension
Absolute contraindications
Tricuspid or pulmonary
stenosis
Right atrial or ventricular
mass
All paediatric congenital heart
disease
Contraindicati
Relative contraindications
ons
Severe arrhythmias
Coagulopathy
Newly inserted pacemaker
wires
Tricuspid/Pulmonary
Regurgitation
ASD/VSD
a. Arrythmia primary
complication
-most common premature
ventricular contractions Complications
-ventricular fibrillation during
b. Right bundle branch block Catheterizatio
c. Complete heart block
Treatment - balloon deflated n
and catheter withdrawn to
right atrium
Catheter knotting
-suspected when difficulty in
withdrawing -diagnosed
with chest x-ray -untied by
radiologist Complications
Thromboembolism rising
incidence -increased with during
antifibrinolytic drugs Catheter
Pulmonary infarction
Infection,endocarditis
residence
Endocardial damage,
cardiac valve injury
Distances
distance to right atrium: 10-
15cm from the subclavian vein,
15-20cm from the jugular vein,
30-40cm from the femoral vein
The right ventricle is another
10cm, and the pulmonary
artery is another 10 cm after
that, and the wedge position a
further 10 cm
Technique of
Pressures
SVC/RA = 0-6 mmHg (at this
insertion
point inflate balloon with 1.5
mL of air)
RV = 25/0 mmHg
PA = 15-30/5-15 mmHg
PAOP = 2-10 mmHg at 40-50
cm distance (if SCV/ IJ insertion)
look for pressure waves to
change as shown below:
Insertion is based on distance + pressure +
waveforms
Overwedging
Troubleshootin
g
Eccentric Balloon
Inflation What to do?
-Ensure balloon is
deflated
-pull back slowly until
PA waveform appears
Troubleshooting

Absent PA wave
Causes: Solutions
Disconnect of monitoring system 1.Check connections
Incorrect scale in use 2. Set correct scale on
Loose or cracked transducer dome monitor
or air in dome 3. Change transducer
Defective transducer 4. Adjust pressure to 300
Inadequate pressure in pressure bag mm Hg
Check for kinks in the system 5. Remove kinks
Catheter tip or lumen totally occluded 6. Slowly aspirate to
check for bloodreturn - if
no blood return, notify
Troubleshooting

Dampened Waveforms
doktor, waveform PA tak cantik la
Reasons:
1. Incorrect scale selected Solutions:
on monitor 1. Check the monitor to
e.g. 200/0, good waveform ensure
will look straight the correct scale is in use
2. Incorrect referencing 2. Check referencing
Using CVP for PA, PA for CVP 3. Check pressure in bag
3. Air in the system 4. Check for loose
4. Spontaneous wedging of connections
catheter (Catheter is 5. Remove air bubbles
advanced too far or is too 6. Flush system
flexible)
Thermodilution technique
CO 4.0-8.0 L/min
CI 2.5-4.0 L/min/m2
SVR 800-1200 dynes/sec/cm -5

SVR = MAP-CVP 80
CO
e.g.
If CVP 15
= 70-15 x80 Cardiac study
4
= 1100
If CVP 10
=70-10 x80
4
=1200
Hence CVP, MAP has to be
accurate for SVR to be
accurate.
Handwashing
aseptic insertion and care
techniques
continuous flush devices
use of disposable (rather than
reusable) transducers
minimizing entry into the
system
The transducers and other Preventing
components of the system
should be replaced at 96-hour infection
intervals.
The pulmonary artery catheter
itself should be replaced every
5 days.

Reference: Pearson, M.L., the Hospital Infection


Control Practices Advisory Committee, Public
Health Service, U.S. Department of Health and
Human Services, & Centers for Disease Control
and Prevention. (1996). Guideline for the
prevention of intravascular device-related
infections.American Journal of Infection Control,
24, 262-293.