How is Swan-Ganz catheterization performed in the workup of cardiac tamponade?

Updated: Nov 28, 2018
  • Author: Chakri Yarlagadda, MD, FACC, FSCAI, FASNC, CCDS; Chief Editor: Terrence X O'Brien, MD, MS, FACC  more...
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Answer

Before or after insertion of the Swan-Ganz catheter, the system must be zeroed after positioning the transducer at the midpoint of the left atrium. Then calibrate the monitoring system. Prior to insertion, test the balloon and flush all of the ports. Then insert the catheter into one of the major veins.

At a depth of 20 cm, inflate the balloon and slowly advance the catheter, while continuously monitoring the pressure from the distal lumen. Always deflate the balloon before withdrawing the Swan-Ganz catheter. The waveforms help to indicate the position of the catheter tip if fluoroscopy is not readily accessible.

At approximately the 40-50 cm mark, the wedge pressure is usually recorded. Secure the catheter position, and obtain a chest radiograph to confirm the position.

In tamponade, near equalization (within 5 mm Hg) of the right atrial, right ventricular diastolic, pulmonary arterial diastolic, and pulmonary capillary wedge pressure (reflecting left atrial pressure) occurs. The right atrial pressure tracings display a prominent systolic x descent and abolished systolic y descent.


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