Swan-Ganz Catheterization

What Is a Swan-Ganz Catheterization?

A Swan-Ganz catheterization is a type of pulmonary artery catheterization procedure.

It’s a diagnostic test used to determine whether any hemodynamic abnormalities exist in the heart and lungs. It can be a useful test for people who have recently had heart problems, such as a heart attack.

The procedure involves the insertion of a pulmonary artery catheter (PAC), also known as a Swan-Ganz catheter or right heart catheter, into the right side of the heart and into the arteries that lead to the lungs. The PAC has a balloon tip. The balloon allows the catheter to be carried by the flow of your blood to the place in your heart where it will be used. Because your blood takes the catheter where it is needed, imaging is not needed to help guide it. Therefore, the procedure can be done at your bedside.

The procedure itself is sometimes called “right heart catheterization.” This is because it can measure the pressure of your blood as it flows through the right side of your heart. It measures the pressure at three different places: your right atrium, your pulmonary artery, and your pulmonary capillaries. These measurements can be used to figure out the amount of oxygen in the blood of the right portion of your heart. It is also used to figure out how much blood flows out of your heart overall.

What Is a Pulmonary Artery Catheter?

A pulmonary artery catheter (PAC) is a long, thin tube with a balloon tip on the end that helps it to move smoothly through the blood vessels and into the right chamber of the heart. The PAC has been in clinical use for more than 30 years. According to Duke Medicine, more than 1 million pulmonary artery catheter procedures are done every year in the United States.

The PAC is a diagnostic tool used to monitor heart and lung function and to evaluate the effectiveness of medications. It’s generally inserted into one of three veins:

  • the right internal jugular vein (RIJ), located in the neck — the shortest, most direct path to the heart
  • the left subclavian vein, located under the clavicle or collar bone — a large vein on the left side of the upper chest area
  • the femoral veins in the groin

In a Swan-Ganz catheterization, the PAC is inserted into one of these access points and guided into the vessels and chambers of the right heart and lung.

Why Is Swan-Ganz Catheterization Performed?

A right heart catheterization evaluates the hemodynamics, or flow of blood, as it circulates through the heart and lungs and into the body. It’s often used to check for complications in the heart, lungs, or kidneys.

The procedure is also used to evaluate:

  • heart failure
  • heart function following a heart attack
  • shock
  • pulmonary edema (fluid in the lungs)
  • congenital heart disease
  • post-op monitoring of open-heart surgery patients
  • valvular heart disease (leaky heart valves)
  • cardiomyopathy
  • pulmonary hypertension

It’s sometimes used in conjunction with an IV. Heart medications can be delivered through the IV and the effects of this medication can be tested and monitored by the Swan-Ganz.

Swan-Ganz catheterization can also be performed in combination with an endocardial (heart muscle) biopsy — removal of a small amount of heart tissue — to prepare for a heart transplant. Pulmonary heart pressure must be as low as possible for heart transplant recipients. The Swan-Ganz can help determine if medications are needed to lower blood pressure.

Preparing for Swan-Ganz Catheterization

You will probably be asked to not eat or drink anything for at least eight hours before the procedure. Some patients will be required to sleep in the hospital the night before the test.

Tell your doctor if you have any allergies, if you’re taking or have taken blood thinners in the recent past, if you’re taking other prescribed or over-the-counter medications, or if you’re pregnant or believe you could be pregnant.

You’ll have to remove any jewelry prior to the procedure.

You will also have to sign a consent form before the procedure to show that you understand the risks. Your healthcare provider will tell you exactly what to expect during the procedure.

Swan-Ganz Catheterization Procedure

The PAC may be inserted while you are in an intensive care unit or a special lab area. The procedure generally follows several steps:

  1. You will be given a sedative to help you relax, but not put you to sleep.
  2. The area where the PAC will be inserted (usually the neck or groin) will be shaved, cleaned, and numbed with local anesthesia.
  3. The doctor will make a small cut to allow the PAC to enter through a vein.
  4. An “introducer sheath” — a hollow tube — will be placed into the vein first. This allows for the catheter to enter your body more easily.
  5. The catheter is then directed through the veins and into the right side of the heart.
  6. The doctor will then measure the blood pressure in the pulmonary artery (the artery that carries blood from the heart to the lungs).
  7. A blood sample may be taken to check blood oxygen levels, or heart medications may be administered to check your heart’s response.
  8. When all the tests are complete, the equipment will be removed and the incision wound will be closed with stitches.

During the procedure, your heartbeat will be closely monitored using an electrocardiogram machine (EKG). You will be awake during the procedure, but you should not feel pain. You may feel a slight pressure where the catheter is inserted.

The amount of time the PAC stays in the heart depends on the patient. The PAC may need to stay in place for a few days for very ill patients who require more intense monitoring.

Risks of Swan-Ganz Catheterization

More common risks of a PAC procedure include:

  • bruising at the site of the PAC insertion
  • excessive bleeding
  • vein injury or tear
  • pneumothorax (lung collapse) as a result of a puncture to the lung (more common when the catheter is inserted into the neck or chest veins)

Less common complications include:

  • blood clots
  • low blood pressure (or hypotension)
  • irregular heartbeat
  • cardiac tamponade, in which blood or fluid builds up around the heart, compressing the heart and resulting in inadequate filling of the ventricles (lower heart chambers)

The most dangerous risk of a PAC procedure is pulmonary artery rupture, which has a 50 percent mortality rate. According to Medscape Reference, this is a rare complication that primarily affects patients over 60 years old who have pulmonary hypertension. It’s also more of a risk for patients receiving anticoagulation (blood thinning) therapy.

Swan-Ganz Catheterization Controversy

Swan-Ganz catheterization and other PACs have been the subject of controversy over the years, in part because of a 1996 study by Case Western Reserve. According to Duke Medicine, the study stated that the PAC procedure might increase the risk of death for critically ill patients.

A series of trials funded by the National Heart, Lung, and Blood Institute stated that the PAC procedure did not increase or decrease the risk of death. However, some of the reported benefits of this hemodynamic monitoring included:

  • better preservation of normal kidney function
  • fewer symptoms of heart failure
  • the ability to walk further than those who did not have a PAC procedure (DM)

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