Pulmonary artery catheter (Swan-Ganz catheter, PA catheter) is a catheter used in medicine to evaluate central hemodynamic parameters.
What does it look like?
The pulmonary catheter in the classic version is a four-lumen catheter with four “tails”: a venous (proximal) port, a temperature sensor connector, a balloon port and a pulmonary (distal) port. Depending on the patient’s height, the catheter may have different sizes (usually 7 F, 110 cm long). The distal port channel opens at the end of the catheter, proximal at a certain distance from it (depending on size, about 30 cm). A balloon is located at the end of the catheter, and a thermal sensor is located a short distance from it.
Types of PA catheters
Currently, there are different types of pulmonary catheters:
- A reduced-type catheter has only a distal port and a canister port. This is an economically cheap option;
- An S-shaped femoral vein catheter;
- A catheter with an additional port for intravenous infusion, the channel of which opens 31 cm from the tip;
- A catheter with a pacemaker;
- A mixed venous blood saturation catheter;
- A catheter for measuring the right ventricular ejection fraction (with a quick-response thermostat);
- A catheter for continuous measurement of cardiac output (with heating element).
History of invention
An article on pulmonary arterial catheter was published in 1970 by Cedars-Sinai Medical Center Los Angeles Clinic doctors Jeremy Swan and William Ganz in the New England Journal of Medicine.
Jeremy Swan, being the head of the cardiology department, dealt with the problem of measuring the parameters of central hemodynamics and their implementation in practical medicine. In those days, it was cumbersome, laborious and dangerous methods. Since the 1950s, Swan has been familiar with the work of his student Ronald Bradley about the technique of a “swimming flexible catheter,” which, when inserted into the jugular vein, independently, passively swam to the right ventricle and pulmonary artery. Swan tried to introduce this method into the clinic, but it turned out to be ineffective and caused many side effects. In 1967, Swan was relaxing with his family on the beach and saw a yacht under a spinnaker sail. It occurred to him to use the same sail principle for a catheter inserted with bloodstream into the pulmonary artery. This idea was realized in the form of an inflated spray can and showed high efficiency and ease of manipulation. And his assistant, Ganz, developed a technique for measuring cardiac output using thermodelation.
Indications for PA catheterization
Currently, due to the widespread use of this technology, indications for PA catheterization are expanding. They include:
- IHD with LV dysfunction or recent MI;
- heart defects;
- heart failure of various origins.
- acute respiratory failure;
- severe chronic obstructive pulmonary disease (primarily COPD).
- assessment of the volemic status in shock, sepsis, acute renal failure, burn disease, acute hemorrhagic pancreatitis during surgical and perioperative period in cardiac patients, during operations on the aorta and other large vessels, during operations on the posterior cranial fossa in a sitting position,
in portal vein bypass surgery, etc.
Contraindications
There are no absolute contraindications to catheterization of the pulmonary artery. Relative contraindications include:
- complete blockade of the left bundle branch block (danger of developing a complete AV block);
- WPW syndrome and Ebstein’s anomaly (danger of tachyarrhythmias);
- hypercoagulation (danger of blood clots);
- hypocoagulation, thrombocytopenia (risk of bleeding);
- sepsis (catheter can be a source of infection).