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, or blood flow-related, 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) 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’ll be used.
Because your blood takes the catheter where it’s needed, imaging isn’t needed to help guide it. Therefore, the procedure can be done at your bedside. The PAC is also known as a Swan-Ganz catheter, or right heart catheter.
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:
- right atrium
- pulmonary artery
- 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’s also used to figure out how much blood flows out of your heart overall.
A PAC is a long, thin tube with a balloon tip on the end. The balloon tip helps the catheter 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 recent literature, it’s not known how often PACs are currently used in the United States.
The PAC is a diagnostic tool used to monitor heart and lung function. It also evaluates the effectiveness of medications. It’s generally inserted into one of three veins:
- Right internal jugular vein (RIJ). This is located in the neck and is the shortest, most direct path to the heart.
- Left subclavian vein. This is located under the clavicle, or collarbone. It’s a large vein on the left side of the upper chest area.
- Femoral veins. These are located 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.
A right heart catheterization evaluates the hemodynamics 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
- pulmonary edema, or fluid in the lungs
- congenital heart disease
- postsurgery monitoring of people who’ve had open-heart surgery
- valvular heart disease, such as leaky heart valves
- pulmonary arterial hypertension (PAH)
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 biopsy to prepare for a heart transplant. The endocardial biopsy focuses on the heart muscle. Pulmonary heart pressure must be as low as possible for heart transplant recipients. The Swan-Ganz can help determine whether medications are needed to lower blood pressure.
You’ll probably be asked to avoid eating or drinking anything for at least eight hours before the procedure. Some people will be required to sleep in the hospital the night before the test.
Tell your doctor if any of the following apply to you:
- You have allergies.
- You’re taking or have taken blood thinners in the recent past.
- You’re taking other prescribed or over-the-counter medications.
- You’re pregnant or believe you could be pregnant.
You’ll have to remove any jewelry prior to the procedure.
You’ll 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.
The PAC may be inserted while you’re in an intensive care unit or a special lab area. The procedure generally follows several steps:
- You’ll be given a sedative to help you relax, but not put you to sleep.
- The area where the PAC will be inserted will be shaved, cleaned, and numbed with local anesthesia so you don’t feel any pain. It’s usually inserted in the neck or groin.
- The doctor will make a small cut to allow the PAC to enter through a vein.
- An introducer sheath, or hollow tube, will be placed into the vein first. This allows for the catheter to enter your body more easily.
- The catheter is then directed through the veins and into the right side of the heart.
- The doctor will then measure the blood pressure in the pulmonary artery.
- A blood sample may be taken to check blood oxygen levels, or heart medications may be administered to check your heart’s response.
- 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 (EKG) machine. You’ll be awake during the procedure, but you shouldn’t 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 person. For very ill people who require more intense monitoring, the PAC may need to stay in place for a few days.
More common risks of a PAC procedure include:
Pneumothorax, or lung collapse, can also occur as a result of a puncture to the lung. This is more common when the catheter is inserted into the neck or chest veins.
Less common complications include:
- blood clots
- low blood pressure
- 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
The most dangerous risk of a PAC procedure is pulmonary artery rupture, which has a
Swan-Ganz catheterization and other PACs have been the subject of controversy over the years. This is in part because of a 1996 study led by Alfred F. Connors, Jr. of Case Western Reserve University. According to
Additional studies have since questioned the usefulness of the Swan-Ganz catheterization as unreliable, inaccurate, and poorly understood and misinterpreted by medical personnel. More recent technologies offer less invasive and reliable results. They include:
- Transesophageal echocardiography. This is a type of echocardiogram. A small transducer is guided down the throat to behind the heart to view any problems.
- Pulse contour technology. This is a noninvasive system that continuously and comprehensively monitors cardiac output using an arterial line, or catheter.
- Dynamic assessment of fluid responsiveness. This is a continuous assessment of how responsive the body will be to adding IV fluid to increase cardiac output. Sometimes giving fluids won’t help increase cardiac output.
Despite these controversies, PAC still has a role in the diagnosis and management of PAH and acute right-ventricular failure.