ICU Care: Swan Ganz Catheter
A Swan? In the Hospital?
Many times, when you have heart problems and are hospitalized because of them, you or your family member may be told they're going to place a pulmonary artery catheter, or a swan (Swan Ganz catheter if you want to get technical). The reasons for wanting to place a swan vary based on the issues you're having, but can include: Heart surgery, heart transplant workup, pulmonary hypertension, or simply for closer cardiac monitoring in very sick ICU patients.
Placement and Positioning
A swan has to be placed through what's called an introducer. This is essentially just a large IV that's in a specific, large vein. Normally, for a swan, that's the right internal jugular vein (right IJ). This vein gives the swan a straight shot to the heart. However, it can be placed through other veins as well.
The swan catheter itself floats down into the right side of the heart and into the pulmonary artery. This artery is the one that leads to the lungs. If you're interested in the specifics of the different chambers of the heart, see my guide on the basics of the heart.
When properly positioned, a swan can monitor a CVP (central venous pressure), PAP (pulmonary artery pressure), cardiac output and index, and SVO2.
Advanced Hemodynamic Monitoring
The CVP is important in acutely ill patients and cardiac patients. It allows the doctors and nurses to monitor fluid volume. A low CVP usually means the patient needs some maintenance fluids or a fluid bolus, whereas a high CVP might indicate the need for diuretics such as lasix or bumex.
PAP monitor the pressure in the pulmonary artery. Increased PAP can indicate pulmonary hypertension and also be useful as a diagnostic tool for other conditions.
Cardiac output, in a nutshell, is how much blood your heart is pumping a minute. Cardiac index is how much blood your heart is pumping in relation to your body weight. These are very important numbers as they directly tell the health care provider how well your heart is performing.
And finally SVO2 is the oxygenation of a mixture of all the blood from your body. It tells the healthcare provider how much oxygen the patients body is using.
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