Swan-Ganz Catheter (Pulmonary Artery Catheter)

History of the Swan-Ganz Catheter


  • In 1970, the Pulmonary Artery (PA) Catheter was First Developed by Swan and Ganz
    • Swan-Ganz Catheter Catheter was Originally Designed to Provide Physiologic Information About Cardiac Function

Indications for Swan-Ganz Catheterization

General Comments

Reasons that Use of the Swan-Ganz Catheter Has Diminished

  • Risk of Swan-Ganz Catheterization
  • Variable Technical Proficiency (from Center to Center) in Swan-Ganz Catheter Management and Data Interpretation
  • Static Variables Obtained from the Swan-Ganz Catheter Poorly Predict Intravenous Fluid Responsiveness
    • Study of Hemodynamic Variables in Predicting Fluid Responsiveness (Chest, 2002) [MEDLINE]
      • Static Hemodynamic Parameters were Found to Be Poorly Predictive of Fluid Responsiveness
  • Studies Have Not Consistently Demonstrated Clinical Benefit from Use of the Swan-Ganz Catheter
    • French Study of Swan-Ganz Catheter in Shock and Acute Respiratory Distress Syndrome (ARDS) (JAMA, 2003) [MEDLINE]
      • Early Swan-Ganz Catheter Use Did Not Impact the Mortality in Shock and/or ARDS
    • Meta-Analysis of Swan-Ganz Catheter Trials in the Intensive Care Unit (JAMA, 2005) [MEDLINE]
      • Swan-Ganz Catheter Did Not Impact the Mortality or Number of Hospital Days
    • PAC-Man Study of Swan-Ganz Catheter Use in the Intensive Care Unit (Lancet, 2005) [MEDLINE]
      • Swan-Ganz Catheter Did Not Impact the Mortality Rate
    • Study of Swan-Ganz Catheter vs CVC in Acute Lung Injury/Acute Respiratory Distress Syndrome (ARDS) (NEJM, 2006) [MEDLINE]
      • Swan-Ganz Catheter Did Not Improve Mortality Rate vs Using a Central Venous Catheter, But Was Associated with an Increased Risk of Complications

Cardiac Surgery

Clinical Efficacy

  • Study of Use of Swan-Ganz Catheter in Coronary Artery Bypass Graft (CABG) Surgery (PLoS One, 2015) [MEDLINE]
    • Swan-Ganz Catheter Use in Coronary Artery Bypass Graft Had No Clinical Benefit or Harm, But was Associated with Increased Cost

Determination of Intracardiac Shunt (see Intracardiac and Extracardiac Shunt)

  • Rationale: utilizing oxygen saturations to detect a “step-up” (due to a left -> right intracardiac shunt)

Diagnosis and Monitoring of Pulmonary Hypertension (see Pulmonary Hypertension)

  • xxx

Differentiation of Cardiogenic vs Non-Cardiogenic Pulmonary Edema/Management of Acute Respiratory Distress Syndrome (ARDS) (see Pulmonary Edema and Acute Respiratory Distress Syndrome)

Clinical Efficacy

  • Study of Pulmonary Capillary Wedge Pressure in Acute Respiratory Distress Syndrome (Intensive Care Med, 2002) [MEDLINE]
    • Median PCWP was 16.6 mm Hg in ARDS Patients
    • Patients Who Met Standard Criteria for ARDS Were More Likely to Have a High PCWP
    • PCWP >18 mm Hg was a Strong Predictor of Mortality in ARDS Patients (After Correction of Baseline Differences)
  • French Study of Swan-Ganz Catheter in Shock and ARDS (JAMA, 2003) [MEDLINE]
    • Early Use of Swan-Ganz Catheter Did Not Improve Morbidity or Mortality in Patients with Shock and/or ARDS
  • Study of Swan-Ganz Catheter to Guide Treatment of Acute Respiratory Distress Syndrome (N Engl J Med, 2006) [MEDLINE]
    • Swan-Ganz Catheter-Guided Therapy Did Not Improve Mortality Rate or Organ Function, But was Associated with More Complications than CVC-Guided Therapy

Recommendations (2016 Surviving Sepsis Guidelines; Intensive Care Med, 2017) [MEDLINE]

  • Swan-Ganz Catheter is Not Routinely Recommended in the Management of Sepsis-Associated ARDS (Strong Recommendation, High Quality of Evidence)

Differentiation of Hypotensive/Shock States (see Hypotension)

  • Hypovolemic Shock (see Hypovolemic Shock)
  • Hemorrhagic Shock (see Hemorrhagic Shock)
  • Distributive Shock
    • Septic Shock (see Sepsis)
    • Systemic Inflammatory Response Syndrome (SIRS)
    • Anaphylactic Shock (see Anaphylaxis)
    • Endocrine/Nutritional Deficiency-Associated Hypotension/Shock
    • Hematologic Disease-Associated Hypotension/Shock
    • Neurogenic Shock (see Neurogenic Shock)
    • Drug/Toxin-Associated Hypotension/Shock
    • Other Types of Distributive Shock
  • Cardiogenic Shock/Severe Congestive Heart Failure (CHF) (see Cardiogenic Shock)
    • Arrhythmogenic
    • Cardiomyopathic
    • Mechanical
  • Obstructive Shock
    • Mechanical
    • Pulmonary Vascular

Management of Cardiogenic Shock

Clinical Efficacy

  • Systematic Review of Impact of Use of Swan-Ganz Catheter in the Management of Cardiogenic Shock (J Crit Care, 2022) [MEDLINE]; n = 1,166,762 (from 6 observational studies)
    • The Most Frequent Etiology of Cardiogenic Shock was Post-Myocardial Infarction (75% [95% CI 55-89%] in Swan-Ganz Catheter Group and 81%[95% CI 47-95%] in Non-Swan-Ganz Catheter Group)
    • Overall, Swan-Ganz Catheter was uUed in 33% (95% CI 24-44%) of Cases
    • Pooling Data Adjusted for Confounders, a Significant Association Between the Swan-Ganz Catheter Group and a Reduction in Short-Term Mortality Emerged When Compared to the Nn-Swan-Ganz Catheter Group (36% [95% CI 27-45%] vs 47% [95% CI 35-59%]; Adjusted Odds Ratio 0.71, 95% CI 0.59-0.87, p < 0.01)
    • Mechanical Circulatory Support Use was Significantly Higher in Swan-Ganz Catheter vs Non-Swan-Ganz Catheter Group (59% [95% CI 54-65%]) vs 48% [95% CI 43-53%]); Odds Ratio 1.60 [95% CI 1.27-2.02, p < 0.01])

Multiple Trauma/Burns (see Burns)

Clinical Efficacy

  • xxx

Perioperative Optimization/Operative Management of Hemodynamics for High-Risk Non-Cardiac Surgery (see Hemodynamics)

Surgical Procedures (Especially in Patients with Suboptimal Cardiac Function)

  • Pneumonectomy

Clinical Efficacy

  • Systematic Review and Meta-Analysis of Swan-Ganz Catheter in the Outcome of Moderate to High-Risk Surgical Patients (Anesth Analg, 2011) [MEDLINE]
    • Preemptive Strategy of Swan-Ganz Catheter Hemodynamic Monitoring and Coupled Therapy Decreased Surgical Mortality and Morbidity

Research Purposes

  • xxx

Ventricular Pacing

  • When Using a Swan-Ganz Catheter with Pacing Capabilities

General Principles of the Swan-Ganz Catheter

Swan-Ganz Catheter Structure

Circulatory Anatomy and Pressure Waveforms from the Swan-Ganz Catheter

Normal Pressure Values

Pressure Transduction with the Swan-Ganz Catheter

Measurement of Cardiac Output (CO) with the Swan-Ganz Catheter

Thermodilution Method

  • Technique: utilizes thermistor on end of Swan-Ganz catheter to measure clearance of cold, injected saline (clearance is proportional to the blood flow rate) -> thermodilution method (based on principles developed by Fick in the late Nineteenth Century) utilizes the temperature change after injection as a function of CO
    • When the CO is high, the injectate is rapidly dispersed and the area under the curve is small -> therefore, area under the thermodilution curve is inversely related to the CO value
  • Variability: variability in CO calculations by thermodilution is approximately 10% (thus, changes in CO should generally be on the order of 15% to be regarded as valid)
  • Falsely Decreased CO
    • Tricuspid Regurgitation (TR) (see Tricuspid Regurgitation): local “recirculation” of injectate -> mimics slow injectate clearance
    • Pulmonic Regurgitation (see Pulmonic Regurgitation): same as for TR
    • Erroneously High Injectate Volume
  • Falsely Increased CO
    • Intracardiac Shunt (in Either Direction) (see Intracardiac and Extracardiac Shunt): alters curve and makes CO calculation less accurate
    • Low Cardiac Output State: injectate can disperse into the surrounding tissue, mimics rapid injectate clearance
    • Erroneously Low Injectate Volume
  • Early Recirculation on Thermodilution Curve: suggests presence of L->R intracardiac shunt
  • “Continuous” Cardiac Output Measurement: PA catheters with capability to measure CO “continuously” (actually averages the CO over a few minute window) are commercially available

Fick Method

  • Technique: utilizes arterial-venous (A-V O2) difference
    • Fick Cardiac Output: Fick CO = O2 Consumption/(10 x A-V O2 Diff)
      • O2 Consumption (Estimated) Can Be Obtained from a Nomogram Which Utilizes Age, Sex, Height, and Weight
      • O2 Consumption Can Also Be Determined Using Breath Analysis
  • Method: based on the concept of the extraction ratio
    • Therefore, changes in peripheral extraction may falsely be interpreted as changes in the CO

Adverse Effects/Complications of Swan-Ganz Catheterization

Complications Related to Placement of the Cordis/Introducer (see Central Venous Catheter)

  • Air Embolism (see Air Embolism)
  • Arteriovenous Fistula
  • Central Venous Catheter-Associated Bloodstream Infection (CLABSI) (see Central Venous Catheter)
    • Prevention
      • Avoid Long Periods of Swan-Ganz Catheter Placement
  • Local Hematoma
    • Mechanism
      • Coagulopathy (see Coagulopathy)
      • Inadvertent Arterial Puncture
  • Local Nerve Injury
  • Pneumothorax (see Pneumothorax)
  • Venous Thrombosis

Complications Related to Swan-Ganz Catheter Itself

  • Air Embolism (see Air Embolism): due to balloon rupture
    • Prevention
      • Avoid Balloon Overinflation
  • Arrhythmia
  • Catheter Knotting in Ventricle
    • Prevention
      • Close Attention to the Length of Insertion While Floating (Inserting) the Swan-Ganz Catheter
  • Endocardial/Valve Damage
    • Mechanisms
      • Inadvertent Withdrawal of Swan-Ganz Catheter with the Balloon Inflated
    • Prevention
      • Withdrawal of Swan-Ganz Catheter with the Balloon Deflated
  • Infection
    • Clinical
    • Prevention
      • Avoid Long Periods of Swan-Ganz Catheter Placement
  • Pulmonary Artery Rupture (see Pulmonary Artery Rupture)
    • Mechanism
      • Balloon Overinflation (Particularly within a Pulmonary Artery Branch Which is Smaller than the Balloon)
    • Prevention
      • Close Observation of Ballon Inflation with Exactly 1.5 ml of Air and Measurement of the Pulmonary Capillary Wedge Pressure Waveform at That Volume
        • Most Swan-Ganz Catheters Come with a Syringe Which Has a Built-In “Lock” Which Disallows Injection of >1.5 mL of Air
  • Pulmonary Infarction (see Pulmonary Infarction)
    • Mechanism
      • Prolonged Balloon Inflation
      • Inadvertent Distal Migration of Swan-Ganz Catheter
    • Prevention
      • Deflate the Balloon After Wedging
      • Evacuate Air from the Syringe and Close Valve After Measuring the Pulmonary Capillary Wedge Pressure (to Prevent Inadvertent Balloon Inflation)



Cardiac Surgery