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Inadvertent fixation of a Swan-Ganz pulmonary artery catheter by a suture is a rare complication. We present a case report of a patient undergoing heart transplantation in whom the catheter was fixed by a suture at the upper venous cannulation site for the cardiopulmonary bypass. After diagnostics with fluoroscopy the chest was reopened and the suture was released. The catheter could then be removed. The patient did not suffer from any consequential damage. Die akzidentelle Fixierung eines Pulmonalarterienkatheters durch eine Naht ist eine seltene Komplikation. Dieser Fall handelt von einem Patienten zur Herztransplantation, bei dem der Katheter mittels Naht an der oberen venösen Kanülierungsstelle der Herz-Lungen-Maschine fixiert wurde. Nach Diagnostik mittels Fluoroskopie erfolgten die Resternotomie und die Lösung der Naht, woraufhin sich der Katheter entfernen ließ. Der Patient trug keine Folgeschäden davon.

Assessing hemodynamics, especially central venous pressure (CVP), is essential in heart failure (HF). Right heart catheterization (RHC) is the gold-standard, but non-invasive methods are also needed. However, the role of 2-dimensional echocardiography (2DE) remains uncertain, and 3-dimensional echocardiography (3DE) is not always available. This study investigated standardized and breathing-corrected assessment of inferior vena cava (IVC) volume using echocardiography (2DE and 3DE) versus CVP determined invasively using RHC. Sixty consecutive HF patients were included (82% male, age 54 ± 11 years, New York Heart Association class 2.23 ± 0.8, ejection fraction 46 ± 18.4%, brain natriuretic peptide 696.93 ± 773.53 pg/mL). All patients underwent Swan-Ganz RHC followed by 2DE and 3DE, and IVC volume assessment. On 2DE, mean IVC size was 18.3 ± 5.5 mm and 13.8 ± 6 mm in the largest deflection and shortest distention, respectively. Mean CVP from RHC was 9.3 ± 5.3 mmHg. Neither 2DE nor 3DE showed acceptable correlation with invasively measured CVP; IVC volume acquisition showed optimal correlation with RHC CVP (0.64; 95% confidence interval 0.46–0.77), with better correlation when mitral valve early diastole E wave and right ventricular end-diastolic diameter were added. Using a CVP cut-point of 10 mmHg, receiver operating characteristic curve showed true positivity (specificity) of 0.90 and sensitivity of 62% for predicting CVP. A validation study confirmed these findings and verified the high predictive value of IVC volume assessment. Neither 2DE nor 3DE alone can reliably mirror CVP, but IVC volume acquisition using echocardiography allows non-invasive and adequate approximation of CVP. Correlation with invasively measured pressure was strongest when CVP is > 10 mmHg.

Background Pulmonary artery thermodilution is the clinical reference method for cardiac output monitoring. Because both continuous and intermittent pulmonary artery thermodilution are used in clinical practice it is important to know whether cardiac output measurements by the two methods are clinically interchangeable. Methods We performed a systematic review and meta-analysis of clinical studies comparing cardiac output measurements assessed using continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients. 54 studies with 1522 patients were included in the analysis. Results The heterogeneity across the studies was high. The overall random effects model-derived pooled estimate of the mean of the differences was 0.08 (95%-confidence interval 0.01 to 0.16) L/min with pooled 95%-limits of agreement of − 1.68 to 1.85 L/min and a pooled percentage error of 29.7 (95%-confidence interval 20.5 to 38.9)%. Conclusion The heterogeneity across clinical studies comparing continuous and intermittent pulmonary artery thermodilution in adult surgical and critically ill patients is high. The overall trueness/accuracy of continuous pulmonary artery thermodilution in comparison with intermittent pulmonary artery thermodilution is good (indicated by a pooled mean of the differences PROSPERO registration number CRD42020159730.

Background The Swan-Ganz catheter plays an important role in gaining understanding of cardiac pathophysiology and in the hemodynamic monitoring of critically ill patients. Difficult removal of the Swan-Ganz catheter is a rare but serious complication. Case presentation This case presents the difficult removal of a Swan-Ganz catheter in a 28-year-old female patient after cardiac surgery. Fluoroscopy and chest X-ray revealed that a portion of the Swan-Ganz catheter was coiled on the central venous catheter at the level of the superior vena cava. Under X-ray guidance, the central venous catheter was first removed, and then the Swan-Ganz catheter was successfully withdrawn through the percutaneous introducer sheath. Conclusions This case report provides an unreported reason for difficult removal and describes a successful solution. This report suggests that X-ray examinations may be necessary before removing the Swan-Ganz catheter.

To determine whether a pulse waveform analysis in the optic nerve head (ONH) circulation as determined by laser speckle flowgraphy (LSFG) can provide systemic hemodynamic values — the systemic vascular resistance (SVR) in particular — similar to those obtained by using a Swan–Ganz catheter, which is an invasive method. Sixteen consecutive subjects were examined. Hemodynamic monitoring was obtained from right heart catheterization with a Swan–Ganz catheter and coronary angiography without an intracoronary nitroglycerin administration. Direct blood pressure was measured with a trans-radial approach. Single regression analyses were used to determine the relationship between the blowout score and blowout time, which are the items of the pulse waveform analysis in the ONH, by using LSFG and the hemodynamic parameters. The blowout time was significantly and negatively correlated with the SVR (r = −0.52, p = 0.04), the ocular perfusion pressure with the mean arterial blood pressure of the radial artery (r = −0.52, p = 0.04) and the radial artery pulse pressure (r = −0.52, p = 0.04).The pulmonary capillary wedge pressure (r = −0.44, p = 0.09) and the mean arterial blood pressure of the radial artery (r = −0.44, p = 0.09) tended to be correlated with the blowout time, but did not reach significance. The blowout score was significantly and negatively correlated with the radial artery blood pressure (r = −0.51, p = 0.046). A pulse waveform analysis in the ONH by LSFG may be one of the useful methods for understanding the SVR.

Background During pulmonary artery catheter (PAC) implantation, inaccurate measurements of hemodynamic parameters due to infection or thrombosis of PAC can result in severe complications. Method In order to develop a new PAC material, we evaluated the antibacterial and antithrombotic activities of the two types of PAC (Swan Ganz catheter and prototype catheter) in 14 pigs. Results In the 3-day group, bacterial infection rate was not different between the two types of PAC. In the 7-day group, bacterial infection rate of the prototype catheter was twice as elevated as that of the Swan-Ganz catheter. In the 3-day group, thrombus formation rate of the prototype catheter was twice as elevated as that of the Swan-Ganz catheter. In the 7-day group, thrombus formation rate was the same for the two types of PAC. Conclusion Here, we report an experimental pig model that confirms differences in antibacterial and antithrombotic activities.

The use of pulmonary artery catheter (PAC) is controversial. The purpose of this study was to document the changing pattern of PAC use and to determine its effect on outcome.The use of PAC was analyzed in patients ≥16 years old admitted to the surgical intensive care unit (SICU) over a 9-year period starting in 2000. Patients with SICU length of stay exceeding 30 days were excluded. For the evaluation of PAC's effect on outcome, PAC and no-PAC patients were matched utilizing propensity scores.During the 9-year study period, a total of 5,192 trauma patients were admitted to the SICU. Of these, 426 (8.2%) were16 years old, and 174 (3.4%) had a SICU length of stay that exceeded 30 days. For the remaining 4,592 patients, the mean ± SD age was 39.5 ± 18.8 years, and the mean ISS was 19.9 ± 12.4. PAC was utilized in 19.5% (n = 896) of all the patients admitted to the SICU. The trend for PAC use decreased significantly over the years (P value for trend0.001), from 38.6% in the year 2000 to 4.2% in the year 2008. This decrease was noted in all age and injury severity groups of patients. The overall mortality, however, remained at the same levels (P value for trend = 0.111). Patients managed with a PAC were significantly older, more severely injured, more frequently injured by a blunt mechanism, and were admitted more often in a hypotensive or comatose status. In the early part of the study, the PAC was utilized on the first day and for 4.1 days on average. In the later part of the study, however, the PAC was used on the second day and for a shorter period of time (3 days on average, P0.001). In the matched study population, patients in the PAC group had almost twofold higher odds for death, when compared to the no-PAC group [34.2% vs. 22.5%, Odds Ratio (95% CI): 1.78 (1.42, 2.26), P0.001]. Patients younger than 50 years of age who had an ISS ≥16 had worse outcome when managed with a PAC, whereas patients aged 30-69 years with an ISS16 had a higher survival. The overall complication rate was fivefold higher in patients receiving a PAC [46.3% vs. 14.2%, Odds Ratio (95% CI): 5.22 (4.04, 6.74), P0.001].The use of PAC has decreased almost 10-fold over the last decade at our institution. The PAC is being used later during the ICU course and for a shorter period of time. In a matched population, the use of PAC is associated with a significantly higher mortality and complication rate, but the reason for this association remains uncertain. The use of PAC is invasive and is associated with known complications and financial costs. While the use of PAC maybe useful in a select population, routine and widespread use of the PAC should be avoided.

Embolism is the most common cause of acute arterial occlusion in the extremities [1]. In majority of the patients, embolectomy is successful if performed within hours of embolism and carries a good prognosis. However, successful embolectomy can be performed even days after an acute occlusion if patient has persistent symptoms of rest pain or claudication pain in the absence of signs of irreversible motor and sensory loss [2]. But, in patients presenting late after embolism, it may be difficult to revascularize the limb as it may be difficult to negotiate the Fogarty catheter across the organized thrombus. We present a case report of a successful brachial artery embolectomy using Swan Ganz catheter threaded over a guidewire in a patient presenting late after axillary artery embolism. Case report

Unilateral giant pulmonary interstitial emphysema (PIE) can be seen as a complication of chronic ventilation in extremely low-birth-weight babies. Many can be managed by conventional pulmonary care which includes positioning, suctioning, chest physiotherapy, gentle conventional ventilation and high-frequency ventilation. Some may need invasive procedures such as lung puncture, pleurotomies and excisional surgery. This is the group in which single-lung ventilation may be beneficial and circumvent the need for an invasive procedure.We describe the technique of single-lung ventilation using a Swan-Ganz catheter to block the main stem bronchus on the diseased side in air-leak syndromes.A retrospective chart review was done on 17 newborns undergoing single-lung ventilation using this technique at the Children's Hospital of New York, Columbia University, from 1986 to 2000.The technique was successful in the management of severe, neonatal unilateral lung disease not responsive to conventional modes of therapy in all but two neonates as seen by a significant improvement in pH and a decrease in PaCO(2) levels. In one neonate malpositioning of the Swan-Ganz catheter balloon could have contributed to the development of pneumothorax.The described technique of single-lung ventilation provides a safe, minimally invasive and economically feasible method of management of unilateral giant PIE in newborns not responsive to conventional modes of therapy with minimal complications.

We experienced anesthetic management for an operation to remove a hemorrhagic gastric submucosal tumor in a patient who had undergone left ventricular volume reduction (the Batista procedure) for dilated cardiomyopathy (DCM) 2 years previously. Preoperative evaluations indicated the relapse of severe DCM. Intravenous and epidural anesthesia was employed with the aid of an intraaortic balloon pump (IABP). Safe anesthetic management was achieved under the guidance of a Swan-Ganz catheter without inducing overreduction of afterload or excessive preload.

By means of a Swan-Ganz catheter cardiac output is calculated using the Stewart-Hamilton thermodilution equation. Assuming the body as a thermally isolated inert system, this equation theoretically always results in zero cardiac output.Using the first and second law of thermodynamics together with a few lines simple analysis this statement is proven.It is at least a necessary condition for the application of the Stewart-Hamilton equation, that core body temperature is kept constant in a thermo- regulatory steady state.

Objective: It has been recently shown that there is a match between dicrotic notch and mean pulmonary artery (PA) pressures in spontaneously breathing patients studied by means of high-fidelity pressure catheters. The aim of the study was to analyze the relation between mean PA pressure and PA pressure at the incisura by using a Swan-Ganz catheter in critically ill, mechanically ventilated patients. Measurements and results: Fluid-filled PA pressures were obtained over four ventilatory cycles in 32 consecutive, mechanically ventilated patients in the intensive care unit. We measured mean PA pressure and dicrotic notch pressure. We also calculated the widely used approximation of mean PA pressure (mean PAPapprox = diastolic + 1/3 pulse pressure). Cardiac output was measured in triplicate by using the thermodilution technique. Dicrotic notch was clearly identified in 30 of 32 patients. Mean PA pressure (32.1 ± 10.2 mm Hg) and PA dicrotic notch pressure (31.8 ± 10.4 mm Hg) were linearly related (r = 0.989, p < 0.001). Agreement between dicrotic notch and mean PA pressures was suggested (mean difference ± SD = − 0.3 ± 1.5 mm Hg). Similar agreement was found between mean PAPapprox and mean PA pressure (mean difference ± SD = − 0.7 ± 0.8 mm Hg; p = 0.20). Conclusion: By using a Swan-Ganz catheter we found that dicrotic notch pressure equalled mean PA pressure in the critically ill, mechanically ventilated patients studied. This indicated that right-sided ejection was completed at a PA pressure equal to mean PA pressure in these patients.

The occurrence of Swan-Ganz (S-G) catheter-induced tricuspid regurgitation (TR) was investigated using transesophageal echocardiography in four patients who underwent laparoscopic cholecystectomy with 12-mmHg pneumoperitoneum. Before pneumoperitoneum, TR was not detected in any of the four patients, despite the presence of an inserted S-G catheter; however, it was detected after completion of 12-mmHg pneumoperitoneum in one of the four patients. This TR was diminished after depneumoperitoneum and the employment of a retraction method by which the intra-abdominal pressure became equal to the atmospheric pressure. This TR was not recognized after the removal of the S-G catheter during 12-mmHg pneumoperitoneum in the same patient. There is a possibility that the S-G catheter induces TR during 12-mmHg pneumoperitioneum.

A 75-year-old woman suffered severe haemoptysis after insertion of a Swan-Ganz catheter in an intensive care unit. Control of the pulmonary artery haemorrhage was quickly and successfully achieved with stainless steel coils as the embolic material.

Inability to withdraw a Swan-Ganz catheter as a result of its intracardiac entrapment is a rare but serious complication. In a normal intracardiac course, the catheter tends to rest against the antero-lateral wall of the right atrium where the catheter may be caught by the suture during cannulation for Cardiopulmonary Bypass (CPB). Entrapment of a Swan-Ganz catheter by the left atriotomy suture is described in this case report.

A case of pulmonary artery rupture induced by balloon occlusion pulmonary angiography (BOPA) is reported. A flow-directed pulmonary artery catheter had been inserted for hemodynamic monitoring in a septic shock patient complicated by acute respiratory distress syndrome. To check for pulmonary damage, BOPA was performed immediately after hemodynamic measurement. Just as the hand injection of contrast medium was ending, the patient began to cough and a small amount of hemoptysis was observed. The angiogram showed the extravasation of contrast medium from the distal pulmonary artery to the situation of catheter tip. Pulmonary hemorrhage was controlled with mechanical ventilatory support with 10 cmH2O positive end-expiratory pressure and no specific therapy was required. This complication should be kept in mind and using a power injector to avoid injurious transient high pressure pulse is recommended.

A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the catheter to be removed without trauma.

The widespread use of the Swan-Ganz catheter is a result of a general misconception. It is widely accepted that the collection of data is a way of practicing scientific medicine. That is simply not true. The data must on balance contribute to a better outcome for patients as established by a scientific trial. The present widescale use of the catheter provides a striking example of the misuse or even mindless use of technology. Because of a tenuous risk-benefit balance, it is not at all certain that the general use of the Swan-Ganz catheter is justifiable and its use at best is semi-scientific. A reasonable approach would be to suspend its use pending an appropriate clinical trial which established safety and efficacy. Although the prospects for a clinical trial are bright, the prospects for a moratorium are not at all bright. While awaiting the results of an appropriate trial, individual physicians should only use the catheter when the probability is high that the data obtained by its use will provide more effective decision making. Such an approach by itself should result in a near-moratorium. Its present use is not a form of scientific medicine but at best a form of semi-scientific clinical practice.

Measurements of pressures across the diaphragm (Pdi) and diaphragmatic electromyogram (EMG) have become an integral tool to study respiratory muscle fatigue. To measure Pdi and diaphragmatic EMG, three balloon catheter systems have to be swallowed; two of these measure esophageal and gastric pressures and the third one, usually a Swan-Ganz catheter records diaphragmatic EMG. In the present study we describe how a thermodilution Swan-Ganz pacing catheter can be very simply modified to measure both Pdi and diaphragm EMG. Because only one catheter has to be swallowed, subject's acceptability improves, particularly for repeated measurements in the same subject. We have used such a catheter system for more than 18 months to study respiratory muscle fatigue in man. The measurements of Pdi by the modified Swan-Ganz catheter compare well with those recorded simultaneously with conventional balloons, and in vitro frequency response measurements showed that amplitude responses differed by 2% at 2 1/2 Hz. Phase responses of the esophageal and gastric balloons were linear over the range of frequencies tested.

Two hundred thirty Swan-Ganz catheters were inserted into 225 patients. Meticulous attention was paid to techniques of insertion and post-insertion catheter care. The preferred route of insertion was via the right internal jugular vein. Minor problems included neck hematomas in 5 attempts (2.2%), catheter migration after insertion in 13 cases (5.6%), and 1 balloon rupture. Only 9 of 230 catheter insertions (3.9%) were associated with major complications. Six of 9 problems, classed as major, were transient arrhythmias which occurred during catheter insertion but were rapidly corrected. In one patient the catheter knotted and had to be removed in the cardiac catheterization laboratory. Two patients (0.9%) suffered non-fatal pulmonary artery injuries. There were no episodes of catheterrelated sepsis nor were there any deaths attributed to the use of the catheter. We conclude that the flow-directed pulmonary artery catheter is a relatively low-risk monitoring device.

Intracardiac knot formation at the distal end of a pulmonary artery catheter in a patient who underwent mitral valve replacement is described. The fluoroscopic methods used to undo the knot were futile. The catheter was finally pulled out after sustained traction which reduced the size of the knot.

With its potential to initiate more serious pulmonary complications, atelectasis requires prompt, effective therapy. We present three cases of patients who, when conventional measures failed, were treated with a technique we devised using a flexible fiberoptic bronchoscope and Swan-Ganz catheter to selectively insufflate the collapsed area. The technique effectively re-expanded the patients' lung.

The use of flow directed Swan Ganz catheters has provided an additional dimension in improving patient care in the intensive care units. We undertook repeated Swan Ganz catheterization in 26 patients with congestive cardiac failure on 65 occasions to evaluate the effect of vasodilator drugs. The same internal jugular vein was used. No significant complications were noted.

A case is described in which voluntary ingestion of 72 g meprobamate (mpb) was complicated by shock ascribed to cardiac failure and vasodilation, documented by hemodynamic monitoring. Forced diuresis and cardiac inotropic support were added to the therapy. We recommend Swan-Ganz monitoring in any case of mpb overdosage associated with hypotension and suggest that forced diuresis is not contraindicated if appropriate assessment of the patient's hemodynamic condition is performed.

A case of collapse of the right middle and lower lobes associated with pulmonary artery catheterisation is described. Possible mechanisms are discussed.

To determine the usefulness of the noninvasive pulsed Doppler in critically ill children, we calculated cardiac output by using this technique and compared the results with values obtained by the thermodilution method. Ten critically ill children who required invasive hemodynamic monitoring with a flow-directed Swan Ganz catheter were selected for this study. The subclavian vein was catheterized in all patients and a #5 Swan Ganz catheter was introduced in 5 patients (ages 8 to 16 years). Fifty-two cardiac output determinations were performed with a Gould SP 1435, 115 VAC, 50-60 Hz thermodilution computer. Simultaneously, patients' ascending aortic blood flows were determined using a Cardioflo (R) pulsed Doppler cardiac output computer (105-125V, 60 Hz by Cardionics, Inc.). A pediatric 3.5 MHz transducer, 6mm diameter, with bidirectional nonfocused capabilities was utilized via a transcutaneous suprasternal approach. After determining Doppler probe position and penetration depth, maximum velocity signals were obtained and a Hewlett Packard adapted flouroscope was used to determine adequacy of ascending aortic wave forms. The diameter of the aorta was measured by m-mode echocardiography and dialed into the computer, which calculated crosssectional diameter of the aorta (A = πd2 T 4cm2). Ascending aortic blood flow (cardiac output) was then derived by using the formula, FLOW = VELOCITY × CROSS-SECTIONAL DIAMETER. Thermodilution cardiac output values were compared with aortic flow calculated from Doppler signals. Linear regression analysis of cardiac output measurements showed to correlate significantly. Linear regression = 0.98, Y intercept = 0.98105X + 0.0687, with a range of 1,620-7,610 ml/min. We conclude that pulsed Doppler determination of cardiac output is a reliable, effective and safe noninvasive method to measure cardiac output in critically ill children.