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A 78-year-old woman visited the division of cardiovascular disease in our hospital. She underwent a cardiac catheter examination, and a Swan-Ganz catheter was inserted. Several minutes later, she developed anaphylactic shock. She had no past history of latex allergy, but did have a banana allergy. Skin prick tests showed a positive reaction to an extract of latex gloves and an extract of the balloon of a Swan-Ganz catheter. Anaphylactic shock caused by the latex balloon of a Swan-Ganz catheter was diagnosed. It is necessary to pay attention to not only latex allergy but also fruit allergies with a cross-reactivity to latex.

Background Pulse-contour analysis method (PCM) cardiac output (CO) monitors are increasingly used for CO monitoring during anaesthesia and in the critically ill. Very recently, several systems have been introduced that do not need calibration; among them the pressure recording analytical method (PRAM). Sparse data comparing the accuracy of the PRAM-CO with conventional thermodilution CO (ThD-CO) in cardiac surgery patients are available. Methods In this prospective comparison study, paired CO measurements with a pulmonary artery catheter and a PRAM monitoring set were obtained 20–30 min apart (t1, t2) in 23 extubated patients on the first postoperative day after cardiac surgery. Data were analysed by the Bland–Altman method. Results A total of 46 paired CO measurements (23 for each interval) were collected. The Bland–Altman analysis showed a mean difference (bias) of 0.0 litre min−1 and limits of agreement (1.96 sd ) of 4.53 to −4.54 litre min−1 [upper 95% confidence interval (CI), 3.26–5.80; lower 95% CI, −5.8 to −3.27]. The percentage error (1.96 sd /mean of the reference method) was 87%. Conclusions These results question the reliability of the PRAM technology for the determination of CO in postoperative cardiac surgery patients.

In a prospective study of 879 triple-lumen catheters, 219 pulmonary artery catheters, 31 double-lumen and six single-lumen catheters used for the administration of total parenteral nutrition over a 1-year period, the overall complication rate was 12-5 per cent (14-7 complications per 1000 catheter-days) and the catheter-related sepsis rate 4·4 per cent (5·2 per 1000 catheter-days). The probability of development of catheter-related sepsis did not increase with the duration of catheterization. There were no differences in the rate of complications associated with 427 catheters changed by replacement at a new site compared with 159 lines changed over a guidewire. These data support the use of multilumen central venous catheters for the administration of total parenteral nutrition. They suggest that a routine weekly change of line is unnecessary; catheters should be changed only on the development of a complication. When it is required, a catheter should be changed by replacement over a guidewire.

We describe a new indicator dilution method of measuring cardiac output in man. A bolus injection of lithium chloride 0.6 mmol was given via a central venous catheter and arterial plasma [Li + ] recorded using a specially developed sensor incorporating an Li + -selective electrode. Cardiac output was derived from the lithium dilution curve, with a correction for packed cell volume. Lithium dilution cardiac output (LiDCO) was compared with thermodilution cardiac output (TD) using 22 lithium sensors in nine patients. For each sensor, one LiDCO was measured immediately before and one immediately after three TD estimations and mean values of LiDCO and TD derived. The correlation coefficient, r , was 0.89; slope of the regression 0.84; Y intercept 0.72; bias 0.3 (0.5) litre min −1 (mean (TD-LiDCO) (1 SD). LiDCO appeared to be a safe, simple and accurate technique which does not require insertion of a pulmonary artery catheter.

The pulmonary artery catheter (PAC) is an invasive hemodynamic monitoring device that is used extensively in critical care units. This technological advance allows the critical care physician and nurse to closely monitor physiological functions at the bedside. There have been no formal evaluations of the impact of this device on patient care. Reviews and observational studies have yielded different conclusions regarding risks and benefits to patients. This has resulted in much editorial comment expressing divergent opinions on the value of the PAC, but there has been no scientific evidence to guide practice and no apparent effect on the use of these devices. The PAC and other medical monitoring devices must be evaluated with respect to their impact on patient care.

Serial changes of hemodynamic parameters were investigated using a Swan-Ganz catheter in 14 patients undergoing laparoscopic cholecystectomy (LAP) and 12 patients undergoing mini-laparotomy cholecyste

Background: Since the development of a Swan-Ganz thermodilution ejection fraction catheter several studies have been published which compare this technique for obtaining right ventricular ejection fraction (RVEFTD) with alternative methods. However, the reliability of RVEFTD measurements under exercise conditions remains undetermined. Therefore, the aim of the present study was a comparative evaluation of RVEFTD with the established gated blood pool method (RVEFGBP) under exercise conditions. Methods and Results: Twenty-two patients with different cardiac diseases underwent right heart catheterization, including RVEFTD and simultaneous RVEFGBP determination at rest and during supine bicycle exercise. Linear regression analysis showed a significant correlation between RVEFTD and RVEFGBP at rest (r = 0.73, p ≤ 0.0005) and during exercise (r = 0.74, p ≤ 0.0005). A Wilcoxon analysis showed a high probability of agreement of RVEFTD and RVEFGBP at rest and exercise (level of significance for error of the 0 hypothesis of 95.9/73.3%). Conclusion: The thermodilution ejection fraction catheter provides a useful device for reliable, repetitive and safe RVEF measurements, not only at rest but also under exercise conditions. This seems to be clinically important, because by it means RVEF, as a sensitive parameter of primary or secondary right ventricular dysfunction, can be determined in the course of standard right heart catheterization.

Many devices are available to assess cardiac output (CO) in critically ill patients and in the operating room. Classical CO monitoring via a pulmonary artery catheter involves continuous cardiac output (CCO) measurement. The second generation of Flotrac/VigileoTM monitors propose an analysis of peripheral arterial pulse waves to calculate CO (APCO) without calibration. The aim of our study was to compare the CO between the Swan Ganz catheter and the VigileoTM. In this observational study, nine patients undergoing coronary artery bypass grafting were prospectively included. APCO, mean (CCO) and instantaneous CO (ICO) were measured. Perioperative and postoperative assessments were performed up to 24 hours post-surgery. Measurements were recorded every minute, resulting in the collection of 6492 data pairs. Comparison of APCO and ICO showed a limited bias of -0.1 l/min but an important percentage error of 48%. Corresponding values were -0.1 l/min and 46% for the APCO versus CCO comparison, and 0 and 17% for ICO versus CCO comparison. Large inter-individual variability does exist. During cardiac surgery and after leaving the operating room, VigileoTM is not clinically equivalent to continuous thermodilution by pulmonary artery catheter. Nevertheless, the connection between CCO and ICO relates the difference between APCO and CCO more to the different algorithms used. Further efforts should be concentrated on assessing the ability of this device to track changes in cardiac output.

Objective: Aim of the study was the evaluation of the impact of lung recruitment maneuvers on the hemodynamics following cardiac surgery procedures. Methods: The prospective randomized study included 80 adult patients undergoing coronary artery bypass surgery from 01/2009 till 09/2009. Patients were randomized to two duration's of lung recruitment maneuvers (25 cmH2O airway pressure for 10s and 45cm H2O for 10s) immediately after arriving on ICU. Swan Ganz catheter measurement was used to calculate cardiac output, and arterial blood pressure were monitored continuously. Systemic and pulmonary arterial blood gases were sampled before and after each lung recruitment maneuver to determine the intrapulmonary shunt. Results: Left ventricular end-diastolic areas decreased significantly during both the 10-s and the 20-s lung recruitment maneuvers. Cardiac output was 5.6±0.8l/min at baseline, decreasing by 3.0±1.1l/min and 3.6±1.2l/min during lung recruitment maneuvers of 10 and 20s, respectively. Shunt decreased from 20±5% to 15±6% after the first lung recruitment maneuver and from 15±6% to 12±5% after the second. Conclusions: Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.

Pulmonary artery catheterization is a useful tool for the diagnosis and management of lung or cardiac disease. This procedure is considered safe and associated with a low incidence of major complications. However, pulmonary artery rupture during right heart catheterization, albeit rare, remains a severe complication. Despite modern management with metal-coil embolization, selective intubation and deployment of bronchial blocker, the mortality rate may be as high as 50%. In this case, we report a new approach to deal with a Swan-Ganz-induced pulmonary artery rupture based on stent graft implantation leading to successful sealing of the pulmonary perforation with final patency and normal antegrade blood flow in the pulmonary branch.

Background and aim Swan-Ganz catheterization is an important technique for monitoring perioperative and postoperative cardiac pressures during open heart surgery. However, although a rare condition, resistance may be encountered while removing the catheter postoperatively and its removal must be accomplished through surgery. Methods Between May 1988 and February 2000, we observed Swan-Ganz catheter entrapment complications in 10 cases subjected to open heart surgery. All the cases had valve replacement. Five cases were male, while five were female. The Swan-Ganz catheter was retained in the vena cava cannulation suture in four cases, in the right atriotomy in three cases, in a left atriotomy suture in one case, and looped around the right ventricular papillary muscle in one case. In the last case, it was looped around chordae tendinea between the tricuspid valve conal papillary muscle and septal leaflet. Although cardiopulmonary bypass equipment was prepared, it was not utilized in any of the cases. The catheter was released and removed by placing a pursestring suture on the vena cava cannulation site in four cases, by placing a matrix suture on the proximal and distal part of the left or right atrial suture line and a purse-string suture on the site of the entrapment in four cases, and by digital palpation from the right atrial appendage in two cases. Results All patients were taken to the intensive care unit postoperatively and to the wards the next day without complications. Conclusions When performing open heart surgery, the surgeon should not leave the Swan-Ganz catheter in the suture while closing the right or left atriotomy or during venous cannulation. In addition, the catheter should be moved after suturing to ensure that there is no entrapment.

Measurement of blood flow rate is essential in assessing the cardiovascular status of patients with coronary artery diseases during treatments. It provides feedback and monitors any improvements in the vascular system after the cardiovascular surgery. This paper presents the latest development of a new approach to measure blood flow rate using a catheter involving the concept of heat exchanger. In the study, an intravascular catheter is inserted into a simulated blood stream and a heat transfer element attached at the distal end extracts a small amount of heat from blood to the cooling fluid in the heat transfer element. We can correlate the blood flow rate to the change of the outlet temperature of the cooling fluid. In this approach, we can determine the cardiac output without the need for introduction of saline solution or other substance into patient body. Unlike Swan-Ganz catheter, it does not alter the blood temperature. Consequently, it is repeatable without any possible adverse effects due to altering blood composition or heating in the vascular system. In this experimental study, we have done the comparison between different designs and settings, and confirmed that this approach has a great potential to be an effective way of measuring blood flow rate as, well as cardiac output.

[Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 72-year-old woman presented with an out-of-hospital cardiac arrest and was successfully resuscitated. She remained in hemodynamic shock. A Swan-Ganz catheter was placed through the right internal jugular vein in the coronary

Pulmonary artery perforation is a rare but often fatal complication of right heart catheterization that is due to Swan-Ganz catheter (Edward Lifesciences, Irvine, Calif) placement.1–3 Treatment of a catheter-induced pulmonary artery rupture includes emergent intubation, lung resection, surgical pulmonary artery repair, and catheter-based pulmonary artery embolization.4,5 This case demonstrates a new therapeutic approach of injecting topical Thrombin-JMI (GenTrac Inc, Middleton, Wisc) through the distal port of the Swan-Ganz catheter to effectively treat a pulmonary artery rupture during a right heart catheterization. The patient was a 72-year-old woman with a past medical history of severe mitral valve regurgitation. Left heart catheterization was performed first with no complications. The coronary angiogram demonstrated minimal luminal irregularities in all 3 major coronary arteries. The left ventriculogram demonstrated +3 …

The Swan-Ganz balloon flotation catheter was introduced in 1970. It can be placed at the bedside within a few minutes even in critically ill patients. Although placement of these catheters is not difficult, some training and experience are required to avoid complications and for proper interpretation of the hemodynamic data that can be obtained by pulmonary artery catheterization. Because of the many advantages of balloon flotation catheters compared with conventional catheters, they have been used without a proper indication and frequently overused in critical care units, resulting in many complications, including mortality. The prospective randomized trials have reported that in the majority of clinical circumstances, the routine use of balloon flotation catheters is not indicated. These results are not surprising because balloon flotation catheters are diagnostic and not therapeutic tools. That we have learned a great deal about hemodynamics in critically ill patients with the use of balloon flotation catheters should not be ignored or forgotten. Furthermore, our clinical knowledge of hemodynamics has been made possible because of extensive experience gained from directly determined hemodynamics with the use of balloon flotation catheters. It should also be realized that despite the introduction and refinement of newer noninvasive imaging modalities, a number of clinical circumstances exist in which determination of hemodynamics with the use of a balloon flotation catheter is necessary and should be considered, but only by experienced physicians. With the proper use of Swan-Ganz catheters, our knowledge of hemodynamics has been enhanced considerably. Its abuse, particularly by relatively inexperienced operators, has resulted in serious complications, including death. Prospective randomized clinical trials have demonstrated that the routine use of Swan-Ganz catheters does not provide any benefit. However, use of the Swan-Ganz catheter is still indicated in many situations.

To delineate the pathogenesis and epidemiology of catheter-related infection with Swan-Ganz pulmonary artery (PA) catheters, a prospective clinical study of hospitalized adult medical and surgical patients was done. Role of catheter material was assessed by randomizing insertions to heparin-bonded PA catheters made of polyvinylchloride or polyurethane. Sources of infection and pathogenesis were studied by culturing skin, the introducer, the PA catheter tip, all hubs, infusate from each lumen, and the extravascular portion of the PA catheter beneath the external protective plastic sleeve. Concordance between isolates from sources and infected catheters was determined by speciation, antibiogram, and for coagulase-negative staphylococci, plasmid profile analysis. Risk factors for infection were determined by stepwise logistic regression. Overall, 65 (22%) of 297 Swan-Ganz catheters showed local infection of the introducer (58 catheters) or the intravascular portion of the PA catheter (20 catheters); only two catheters (0.7%) caused bacteremia. Eighty percent of infected Swan-Ganz catheters (the introducer or PA catheter) showed concordance with organisms cultured from skin of the insertion site, 17% with a contaminated hub and 18% with organisms contaminating the extravascular portion of the PA catheter beneath the sleeve. Isolates from infected PA catheters were most likely to show concordance with concomitantly infected introducers (71%). Cutaneous colonization of the insertion site with greater than 10(2) cfu/10 cm2 (relative risk [RR] 5.5; p less than 0.001), insertion into an internal jugular vein (RR 4.3; p less than 0.01), catheterization greater than 3 days (RR 3.1; p less than 0.01), and insertion in the operating room using less stringent barrier precautions (RR 2.1; p = 0.03) were each associated with a significantly increased risk of catheter-related infection. The risk of bacteremic infection with Swan-Ganz catheters is now low, in the range of 1%, with reasonable care. Swan-Ganz catheters are vulnerable to contamination from multiple sources, but the patient's skin is the single most important source of organisms causing invasive infection, which in most cases involves the introducer rather than the PA catheter. Heavy colonization of the insertion site, percutaneous insertion in the internal jugular vein rather than subclavian vein, catheterization longer than 3 days, and insertion with less stringent barrier precautions significantly increase the risk of catheter-related infection. These findings hold promise for application to management of Swan-Ganz catheters and research in catheter design to reduce the risk of catheter-related infection.

We experienced a rare case of a patient with acute myocardial infarction. It was rare in that a piece of tissue, probably a remnant valve of the inferior vena cava in the right atrium, was dislodged by the Swan-Ganz catheter during a right heart catheterization study in the chronic phase of the disease. As far as we know, no other such case has been reported. Such remnants are considered to be present in 2 to 3% of the general population. Therefore, it is necessary to determine the presence or absence of a remnant before cardiac catheterization and to modify the procedure, such as by changing the catheter's approach, when a remnant is present.

Oxygen consumption calculated by the direct Fick method using a Swan-Ganz catheter (D-VO2) and indirect calorimetry using a metabolic computer (ID-VO2), carbon dioxide production calculated by the latter method, and respiratory quotient were determined pre- and postoperatively in 12 patients with acute hypertensive intracerebral hemorrhage and eight patients with acute ruptured intracranial aneurysm. The mean D-VO2 value was slightly lower than the mean ID-VO2 value, but had a significantly positive correlation. The regression curve was very close to the line of identity. The total metabolic expenditure can be calculated from D-VO2 and daily urinary nitrogen excretion. Direct calorimetry using a Swan-Ganz catheter is a simple method to evaluate metabolic expenditure in acute hemorrhagic cardiovascular disease.

We report on a case of temporary closure of a post-infarction ventricular septal defect (VSD) using a Swan-Ganz catheter through a femoral transvenous approach. This resulted in substantial improvement in the hemodynamic status of the patient. Six hr later, the patient underwent surgery for VSD closure. When immediate surgical intervention is not possible, it may be helpful to stabilize the patient until surgery can be performed. Thus, such a treatment has potential as a temporary measure for patients awaiting surgical repair of post-infarction VSD.

DOI: http://dx.doi.org/10.5915/40-2-4450 Since its introduction in 1970, the Swan-Ganz catheter (SGC) has been used extensively, particularly in critical care units. A recent well-designed randomized clinical trial confirmed earlier suspicions that the widespread use of the SGC caused more harm than good. This account of historical SGC use has some valuable lessons for all practitioners, who at times tend to embrace and overuse the ever-increasing diagnostic or therapeutic modalities without fully assessing the risk/benefit ratio.

Cardiac output is considered an important parameter when assessing the cardiovascular status of a critically ill patient. Both non-invasive (e.g. bioimpedance, echocardiography) and invasive methods (Swan Ganz catheter) have been used to measure cardiac output. The ultrasonic cardiac output monitoring device provides a new method of non-invasively assessing cardiac output in various clinical settings. The ultrasonic cardiac output monitoring device was introduced clinically in 2001, and appears to be a promising adjunct in the assessment of the cardiovascular state in a variety of patient cohorts. In this short review article, we will introduce this new technique, discuss the required skills and compare it with methods already in use. In particular, a critical comparison with the 'gold standard', the invasive measurement of cardiac output with the pulmonary artery catheter, will be given.

We present a case of a 69-year-old male patient who, after uneventful coronary artery bypass grafting, had a Swan-Ganz catheter entrapped in the tricuspid apparatus. An original technique to remove the catheter percutaneously was used after unsuccessful attempts using a conventional lasso technique.

BACKGROUND: We compared cardiac output (CO) measurements by the non-invasive electrical velocimetry (Aesculon) monitor with the pulmonary artery catheter (PAC) thermodilution method in children. METHODS: CO values using the Aesculon monitor and PAC thermodilution were simultaneously recorded during cardiac catheterization in children. Measurements were performed under general anaesthesia. To compare, three consecutive measurements for each patient within 3 min were obtained. The means of the three values were compared using simple regression and Bland-Altman analysis. Data were presented as mean (sd). A mean percentage of

An eclamptic primigravid patient is presented in whom central monitoring by a Swan-Ganz pulmonary artery catheter led to a series of complications, including the Mendelson's syndrome of necrotisizing pneumonia, resulting in severe maternal morbidity and in fetal mortality.

The significance of early and appropriate treatment is emphasized for a rare complication of pulmonary hemorrhage caused by SGC which has rapid onset and progression in the course with a resulting high mortality. The mechanisms of the onset, condition, and treatments were also discussed from a review of the literature. We reported a case of pulmonary hemorrhage induced by Swan-Ganz catheter. In a 68-year-old woman admitted for CABG in the treatment of angina after infarct, A 7F Swan-Ganz catheter was inserted under pressure monitoring and general anesthesia in the operation room. We confirmed that the tip of catheter was wedged in the pulmonary artery on the chest X-ray film and the pressure curve in the monitor. Just while the tip of catheter was pulled, massive bleeding was observed from the endotracheal tube. For this, the respirator setting was changed and hyperventilation and high PEEP were tried. These treatments were effective for hemostasis in the lung, so she could be weaned from respirator and extubated about 9 hours after operation. The patient was discharged on the 31st day after operation with a good condition.

Failure to withdraw a catheter is related primarily to catheter entrapment or knotting. Placement of a Swan-Ganz catheter is associated with various complications, one of which is entrapment. Entrapment of a Swan-Ganz catheter in the heart, vena cava, or pulmonary artery is a very rare and serious complication that may lead to life-threatening complications if not treated appropriately. Most reported cases of catheter entrapment have been associated with surgical sutures, artificial valves, or abnormal cardiac anatomy. Here we report a rare case of Swan-Ganz catheter entrapment resulting from inserting an excessive length of Swan-Ganz catheter into the heart. The catheter was removed smoothly under fluoroscopic guidance.

Catheters and pacing leads may become entrapped within the heart necessitating the use of creative measures for extraction while preventing damage to cardiac structures. This report describes the percutaneous extraction of a knotted pulmonary artery catheter and an entrapped tined pacing lead in two dogs. In both cases, a long transseptal sheath was advanced over the catheter or pacing lead and used to facilitate removal of the entrapped devices without causing damage to the heart.

Knotting of intravascular catheters is an uncommon but a well-recognized occurrence. The Swan-Ganz catheter (SGC) is the one that knots most commonly. A case of a knotted SGC is described in a patient with a persistent left-sided superior vena cava, and we propose that the presence of a left-sided superior vena cava is a risk factor for knot formation not previously reported. We review the published work on the risk factors for knot formation and on the techniques used to remove knotted SGC. We describe a technique using a gooseneck snare and Omni Flush catheter (Angiodynamics, Queensbury, NY, USA) to loosen and untie a knotted SGC.

ObjectivesThe goal of this work was to evaluate the accuracy of a new heart failure (HF) sensor (HFS) (Heart Failure Sensor, CardioMEMS Inc., Atlanta, Georgia) pulmonary artery pressure (PAP) monitoring compared with Swan-Ganz (SG) (Hospira, Inc., Lake Forest, Illinois) catheterization and echocardiography (ECHO) in ambulatory HF patients.BackgroundThere is an increasing interest in the development of ambulatory monitoring devices aiming to adjust therapy and prevent hospitalizations in HF patients.MethodsTwelve patients with HF and New York Heart Association functional class II to IV were included in this study. The HFS was deployed into the pulmonary artery under angiography, allowing wireless PAP measurement. Two independent blind operators performed 3 HFS measurements at each visit, with simultaneous ECHO at 2, 14, 30, 60, and 90 days. Swan-Ganz catheterization was performed at 0 and 60 days. Linear regression was used as a measure of agreement. Variability between methods and interobserver variability were evaluated by Bland-Altman analysis.ResultsMean age was 63 ± 14.6 years. Systolic PAP was 64 ± 22 mm Hg and 58 ± 22 mm Hg for HFS and SG, respectively (p < 0.01). Both methods showed a significant correlation (r2= 0.96 baseline, r2= 0.90 follow-up, p < 0.01), with a mean difference of 6.2 ± 4.5 mm Hg. Diastolic PAP was 23 ± 14 mm Hg and 28 ± 16 mm Hg for HFS and SG, respectively (r2= 0.88 baseline, r2= 0.48 follow-up, p < 0.01), with a mean difference of −1.6 ± 6.8 mm Hg. Systolic PAP was 60 ± 20 mm Hg and 62 ± 12 mm Hg for HFS and ECHO, respectively (r2= 0.75, p < 0.01), with a mean difference of −2.6 ± 11 mm Hg. There was no significant interobserver difference.ConclusionsThe HFS provides an accurate method for PAP assessment in the intermediate follow-up of HF patients.

We present a case report of an anticoagulated 78-year old man presenting a pulmonary artery pseudoaneurysm following Swan-Ganz catheter deployment after an aortic valve and aortic root replacement. Diagnosis was established by cone beam CT angiography and catheter angiographyand embolisation was achieved via a combination of plug and glue. This case emphasises the importance of endovascular techniques in the management of iatrogenic pulmonary pseudoaneurysms and shows the benefit of using highly hemostatic polymeric agent in anticoagulated patients to obtain a rapid and effective occlusion.

zation among heart failure patients in the post-ESCAPE era are not known. In this study, we aim to determine the temporal trends in use of swan-ganz catheterization among hospitalized heart failure patients between 2004 and 2012. Methods: The 2004-2012 Nationwide Inpatient Sample (NIS), the largest database of in-patient hos- pital stays in the US, was used to identify hospitalizations with primary diagnosis of heart failure among patients $16 years using ICD-9 codes 402.xx, 404.xx, and 428.xx. Use of swan-ganz catheterization for monitoring among these patients was identified using the clinical classification software procedure code 204. Primary outcome of interest was annual swan ganz catheterization per 1000 heart failure ad- missions during the study period. Results: There were 9.2 million hospitalizations with a principal diagnosis of heart failure from 2004 - 2012 (mean age 72.6 years, 51% were women). The overall rate of utilization of swan-ganz catheterization was 6.2 per 1000 heart failure hospitalizations. There was a significant increase in the proportional utilization of swan-ganz catheterization from 5.7 per 1000 heart fail- ure admissions in 2004 to 8.9 per 1000 heart failure admissions in 2012 (p!0.001 for linear trend). In contrast, among patients who died during hospitalization, a group whose disease severity may be consistent across time, there was a relative decline in proportional utilization of swan ganz catheterization (3.05 per 1000 heart failure admissions in 2004 to 2.54 per 1000 heart failure admissions in 2012 (P-trend 5 0.02). Conclusions: Proportional utilization of swan-ganz catheters among patients hospitalized for heart failure has increased over time in the post ESCAPE era. This increase is likely due to its greater use in patients with less severe disease. ally, HFrEF was diagnosed in 0.045% in the total population, 0.69% of HbSS, 0.48% of HbS, 1.47% of HbSb, and 1.85% of HbSC. Compared with the total population, there was an increased prevalence of HFrEF in patients with HbSS (OR 15.4 (95% CI: 11.5-20.5), p!0.001), HbS (OR 10.6 (95% CI:8.3-13.5), p!0.001), HbSb (OR 33.1 (95% CI:16.7-63.4), p!0.001), and HbSC (OR 41.8 (95% CI:21.1-80.3), p!0.001). Conclusions: Patients with sickle cell variants are at an increased risk of heart failure with increased age. The prevalence of heart failure is higher in males compared to females except for HgSc. Patients with sickle cell variants are at an

A wide spectrum of complications is associated with invasive hemodynamic monitoring. We report an unusual case of perforation of the left internal mammary artery that occurred during percutaneous insertion of a Swan-Ganz catheter using the subclavian vein approach. To the best of our knowledge, this complication has not been previously reported. Cathet. Cardiovasc. Diagn. 44:317–319, 1998. © 1998 Wiley-Liss, Inc.

Knotting of a balloon-tipped, flow-directed catheter leading to difficulty in its removal is a rare but serious complication. Several methods have been used to remove such catheters with nonsurgical techniques. A case of knotted catheter that was also entrapped in a surgical suture in a patient undergoing emergency mitral valve replacement is presented and a method for its nonsurgical removal is described. Cathet. Cardiovasc. Diagn. 43:87–89, 1998. © 1998 Wiley-Liss, Inc.

The in memoriam article about Jeremy Swan [1] coincided with the recent report by the National Heart, Lung, and Blood Institute Acute Respiratory Disease Syndrome (ARDS) Clinical Trials Network [2]. The latter may sound like the last nail on the coffin of the Swan–Ganz catheter. The controversy surrounding the benefits and risks of the use of the Swan–Ganz catheter is nothing new. It was merely a decade ago that a series of articles in JAMA [3,4] suggested that a moratorium be placed on its continued use. However, the editorial [5] accompanying the ARDS article has a more sobering tone: “It still has a role in diagnosis and in certain types of treatment, particularly the treatment of patients with suspected pulmonary arterial hypertension and right ventricular dysfunction [5]”. I also concur with Shure [5] that Swan–Ganz catheter may also have a role in patient populations not included in the NHLBI study [2], such as those with severe chronic obstructive pulmonary disease or with conditions requiring complex fluid management. As for a moratorium on the use of the Swan–Ganz catheter, only a bad workman blames his tools [6]. Perhaps it is not the Swan–Ganz catheter but the technique of placement or the treatment following its use that is at fault [6]. Furthermore, as Shure [5] said in her editorial, if an effective new therapeutic modality that requires information obtained only by the Swan–Ganz catheter emerges, the latter still will play an important role in management of such patients. Therefore, with the passing of

Until recently, more than 2200 Swan Ganz catheters were used annually in the operating rooms (OR) and intensive care unit (ICU) of the Catharina Hospital in Eindhoven, The Netherlands. After cardiologists who were specialists in echocardiography (ECHO) trained anesthesiologists in ECHO, the need for these catheters in cardiac and noncardiac surgery was reduced. Initially intended as a local teaching project, an ECHO teaching compact disk (CD) was produced during the training and distributed later worldwide, thanks to a positive review in a major anesthesiology publication. By reducing the number of Swan Ganz catheters, the hospital could finance and acquire two echocardiography machines for the OR and ICU. The availability of these machines resulted in a further reduction of the number of Swan Ganz catheters. However, the need for quantification (eg, measurements of cardiac output) remained. During the creation of the ECHO teaching CD, the idea was born to apply indicator-dilution principles on injected echo contrast. This study was performed in cooperation with the Signal Processing Department of the Eindhoven University of Technology. Advanced signal processing and modelling were used to develop algorithms to enable quantification of intrapulmonary blood volume, ejection-fraction, and flow from the transesophageal echocardiography approach. These quantitative measurements, which can be performed on an outpatient basis, may become a real asset in cardiology, anesthesiology, and intensive care.

Digital subtraction angiography is an indispensable complement to cut film studies for the detection of pulmonary artery injury. Immediate transcatheter embolization of catheter-induced pulmonary artery pseudoaneurysm is a safe, minimally invasive, fast, and cost-effective alternative to surgical treatment.

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.

The improvement in lung function, exercise test, blood gas levels, and symptoms in emphysema patients after volume reduction surgery is a result of improvements in breathing mechanics. The question is, is the improvement in the condition related to pulmonary hemodynamics? Few studies have examined pre- and postoperative pulmonary pressure. This paper examines whether there is any significant change in systolic and diastolic pulmonary pressure after effective volume reduction surgery. From October 1999 to October 2002, 12 emphysema patients who underwent volume reduction surgery were studied. Systolic and diastolic pulmonary pressures were measured 2 days before surgery through cardiac catheterization and 2 days after removal of the chest tubes through Swan Ganz catheters placed in the operating room just before surgery. Patients were stable and breathed without assistance during the postoperative pressure measurement. Blood gas analysis, lung function tests, and a 6-minute walk test were performed preoperatively and 3 months postoperatively. The two sets of data were compared using the Wilcoxon signed rank test. There was no significant change in pulmonary hemodynamics, although pulmonary function improved. The improvement in pulmonary function after volume reduction surgery is not related to pulmonary hemodynamics.

The author describes his experience with a "saline-filled central venous catheter electrocardiographic lead" for the recording of intracardiac electrocardiograms provides a brief description of the methodology, refers to this modality's clinical usefulness, furnishes 2 examples illustrating the contribution of the method to clinical diagnosis, and outlines his literature search to find the discoverer/originator of the employment of a saline-filled intracardiac catheter as an electrocardiogram recording lead.

Objective To evaluate the effect of an open-chest condition on oxygen delivery in anesthetized dogs. Study design Prospective, controlled experimental study. Animals Eight clinically normal adult Walker Hound dogs weighing 25.6–29.2 kg. Methods Eight anesthetized dogs underwent an open-chest operation after the insertion of thoracoscopy cannulae in the lateral chest walls . A Swan Ganz catheter was used to both measure hemodynamic parameters and obtain mixed venous blood samples for blood gas analysis. A dorsal pedal catheter was placed to both measure arterial blood pressure and obtain blood samples for blood gas analysis. Oxygen delivery index and oxygen extraction ratio were calculated. A randomized block anova for repeated measures was used to evaluate the effect of the treatment on hemodynamic and pulmonary parameters. Results Creation of an open chest did not significantly affect oxygen delivery index (DO2I; p = 0.545). It induced a significant decrease in arterial oxygen partial pressure (PaO2; p = 0.018) and arterial oxygen content (CaO2; p = 0.025). It induced a significant increase in shunt fraction (p = 0.023), physiologic dead space (p = 0.015), and alveolar-arterial oxygen difference (p = 0.019). Arterial partial pressure of carbon dioxide (PaCO2; p = 0.766) and arterial hemoglobin oxygen saturation (SaO2; p = 0.178) were not significantly affected. Diastolic (DPAP; p = 0.050) and mean (MPAP; p = 0.033) pulmonary arterial pressures were significantly increased by opening the chest. Other hemodynamic parameters were not significantly affected. Conclusions Opening the thoracic cavity is not detrimental to hemodynamic function and oxygen delivery in normal dogs, although impaired gas exchange does occur. Clinical relevance Close monitoring of patients is recommended during open-chest thoracoscopy as adverse effects on gas exchange can contribute to hypoxemia.

Complications associated with the use of the Swan–Ganz catheters including coiling and knotting of the catheter in the central venous system or in the chambers of the heart, often with disastrous consequences. We report a case of knotting of a Swan–Ganz catheter in the superior vena cava which necessitated surgical removal via the right internal jugular vein.

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.

This study compares the correlation between two methods for the determination of cardiac output-the pulmonary arterial thermodilution technique using the Swan-Ganz catheter and the femoral arterial thermodilution technique using a pulse contour analysis computer (PiCCO) catheter. We performed a prospective animal study using 16 immature Maryland pigs weighing 9 to 16 kg. A 5.5- or 7.5-Fr Swan-Ganz catheter was introduced into the femoral or jugular vein, and a 4- or 5-Fr arterial PiCCO catheter was introduced into the femoral artery. In each animal, we made measurements of cardiac output at 30-minute intervals, simultaneously by pulmonary arterial thermodilution and femoral arterial thermodilution, before, during, and after hemodiafiltration carried out via different venous catheters, recording a total of 78 measurements. The mean Swan-Ganz cardiac output was 2.22 +/- 0.94 L/min, and mean PiCCO cardiac output was 1.94 +/- 0.80 L/min (no significant difference). The mean difference (bias) of differences (limits of agreement) was 0.2812. The differences between the methods increased with higher cardiac output, but the percentage differences in relation to cardiac output remained stable. Good correlation was found between the two methods: single-measure intraclass correlation was 0.8892 (95% confidence interval, 0.54-0.95). There were no differences between the 5.5- and 7.5-FR Swan-Ganz catheters or between the 4- and 5-Fr PiCCO catheters. Femoral arterial thermodilution cardiac output measurements correlated well with pulmonary arterial thermodilution cardiac output measurements in a pediatric animal model.