PA catheters/swan ganz

Published

I am an experienced surgical nurse who is going to be transitioning to the ICU in one month. I have been studying different critical care topics to prepare, and there is one that I just can't grasp. I have been studying PA catheters for a while now, and for some reason the concept isn't clicking. I understand that it helps monitor the different pressures, but I just don't understand what those pressures mean, and how they change the course of treatment. Could someone describe a patient case where a PA catheter was placed, and what the different readings were, and how those changes therapies. What I understand is that the different PAWP readings help differentiate between fluid overload and HF.

I think hearing about a case study on a patient would help me extrapolate all of the information to truly understand the monitoring/nursing responsibilities.

Any help is appreciated!!!

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

As Swan Ganz catheter or PA line is a flow-directed balloon-tipped pulmonary artery catheter (PAC) (also known as the Swan-Ganz or right heart catheter). Pulmonary artery catheterization is a diagnostic procedure in which a small catheter is inserted through a neck, arm, chest, or thigh vein and maneuvered into the right side of the heart, in order to measure pressures at different spots in the heart. Pulmonary artery catheterization is performed to:

  • evaluate heart failure
  • monitor therapy after a heart attack
  • check the fluid balance of a patient with serious burns, kidney disease, or after heart surgery
  • check the effect of medications on the heart

Pulmonary artery catheterization is not without risks. Possible complications from the procedure include:


    • infection at the site where the catheter was inserted
    • pulmonary artery perforation
    • blood clots in the lungs
    • irregular heartbeat

  • Normal results
    Normal pressures reflect a normally functioning heart with no fluid accumulation. These normal pressure readings are:

    • right atrium: 1-6 mm of mercury (mm Hg)
    • right ventricle during contraction (systolic): 20-30 mm Hg
    • right ventricle at the end of relaxation (end diastolic): less than 5 mm Hg

    • pulmonary artery during relaxation (diastolic): about 10 mm Hg
    • mean pulmonary artery: less than 20 mm Hg
    • pulmonary artery wedge pressure: 6-12 mm Hg
    • left atrium: about 10 mm Hg

    Abnormal results

    Abnormally high right atrium pressure can indicate:

    • pulmonary disease
    • right side heart failure
    • fluid accumulation
    • compression of the heart after hemorrhage (cardiac tamponade)
    • right heart valve abnormalities
    • pulmonary hypertension (high blood pressure)

    Abnormally high right ventricle pressure may indicate:

    • pulmonary hypertension (high blood pressure)
    • pulmonary valve abnormalities
    • right ventricle failure
    • defects in the wall between the right and left ventricle
    • congestive heart failure
    • serious heart inflammation

    Abnormally high pulmonary artery pressure may indicate:

    • diversion of blood from a left-to-right cardiac shunt
    • pulmonary artery hypertension
    • chronic obstructive pulmonary disease or emphysema
    • blood clots in the lungs
    • fluid accumulation in the lungs
    • left ventricle failure

    Abnormally high pulmonary artery wedge pressure may indicate:

    • left ventricle failure
    • mitral valve abnormalities
    • cardiac insufficiency
    • compression of the heart after hemorrhage

    Diagnostic Swan Ganz

  • Diagnosis of shock states
  • Differentiation of high- versus low-pressure pulmonary edema
  • Diagnosis of idiopathic pulmonary hypertension
  • Diagnosis of valvular disease, intracardiac shunts, cardiac tamponade, and pulmonary embolus (PE)
  • Monitoring and management of complicated AMI
  • Assessing hemodynamic response to therapies
  • Management of multiorgan system failure and/or severe burns
  • Management of hemodynamic instability after cardiac surgery
  • Assessment of response to treatment in patients with idiopathic pulmonary hypertension

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

another resource is go to icufaq's.org and click on PA lines.

An example you have a patient in shock and you don't know what kind of shock they have. The MD places the PA line and you record the numbers do a cardiac output and you can tell from there whether to give fluid or inotropes or both.

High cardiac output, low SVR, low wedge...fluid and inotropes

Low cardiac output, high SVR, high wedge: inotropes, preload after load reductors, laxix

Up Vote Up Vote ×
Specializes in SICU.

Good info.

The whole point is that the numbers which represent pressure are a indirect measurement of volume. We use the numbers to estimate how much volume is in that space and guide therapies from that point.

And FYI, if your ICU uses them with any consistency, you should get a solid class from your hospital explaining in gory detail the in's and out's of PA catheter results.

Plus, it takes time to fully grasp and put into action. Stories you read here are one thing, but actual patients you take care of will really solidify meaning into your head

Up Vote Up Vote ×
Specializes in critical care.

High cardiac output, low SVR, low wedge...fluid and inotropes

Low cardiac output, high SVR, high wedge: inotropes, preload after load reductors, laxix

I understand how PA catheters work (my unit educator let me take one home and it decorated my Christmas tree 2 years ago.) :) I just have trouble translating the numbers into treatments. I only really see them in cardiology patients where they are used to guide inotrope therapies. They seem to be out of style for non-cardiac patients entirely, and I don't care for cardiac surgery patients, where they are used constantly. So my view is very narrow.

I would think that with high CO, low SVR and low wedge, you would give fluid and pressors (e.g. Levo, Neo) instead of inotropes (e.g. dobutamine). Just my thinking. Esme, can you explain?

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
I understand how PA catheters work (my unit educator let me take one home and it decorated my Christmas tree 2 years ago.) :) I just have trouble translating the numbers into treatments. I only really see them in cardiology patients where they are used to guide inotrope therapies. They seem to be out of style for non-cardiac patients entirely, and I don't care for cardiac surgery patients, where they are used constantly. So my view is very narrow.

I would think that with high CO, low SVR and low wedge, you would give fluid and pressors (e.g. Levo, Neo) instead of inotropes (e.g. dobutamine). Just my thinking. Esme, can you explain?

Thank you.... I should had been more specific and said positive inotropes/vasoconstrictors..... dopamine, levo and epi....and negative inotropes/vasodilators. I had it clearly in my head.

They have fallen into disfavor in some facilities...some facilities use them a lot. Physician preference. have seen both schools of thought.

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

clarification of my above post since you can't hear what my brain us saying...;)

another resource is go to icufaq's.org and click on PA lines.

An example you have a patient in shock and you don't know what kind of shock they have. The MD places the PA line and you record the numbers do a cardiac output and you can tell from there whether to give fluid or positive inotropes/vasoconstrictors or both.

High cardiac output, low SVR, low wedge...fluid and "positive" inotropes/vaso-constrictors

Low cardiac output, high SVR, high wedge: "negative" inotropes/vasodilators, preload after load reductors, lasix....some of these patients will also need positive inotropes for low B/P/cardiac output and that is when a delicate balance and multidrip titration such as Epi (levo/dopa)/Nipride (nitro)/dobutamine/ are titrated for effect.

another good source.....http://www.cardionursing.com/pdfs/Drugs-BW-for-website.pdf
Up Vote Up Vote ×
Specializes in Dialysis.

Preload, afterload, contractility. A PA catheter answers those questions.

Up Vote Up Vote ×

They are on their way OUT. The risk to benefit ratio sucks! I have seen countless times the pressures are reported faithfully and the MD does nothing anyway!

Up Vote Up Vote ×
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
They are on their way OUT. The risk to benefit ratio sucks! I have seen countless times the pressures are reported faithfully and the MD does nothing anyway!
For some applications yes....but they are still vital in other patient populations....like cardiac. I also find this a physician preference thing.
Up Vote Up Vote ×
Specializes in Cardiovascular ICU.

If you get a chance to lay hands on one, I guarantee it will start to make more sense. I work in a CVICU and every single one of our open hearts comes back with one. They have not, by any means, gone out of favor with our surgeons and they will actively treat based on the numbers we report. We use Flo-Tracs on occasion, but they can be pretty unreliable at times. We don't wedge our Swans either unless we are helping our surgeon insert one at the bedside. Some examples as to how we use it and report it: I've got a CABG whose pressure is dropping in the 80s with a PA diastolic of 5, CVP of 2, SVR of 650, and a CI of 1.8. The surgeon is going to give volume first and he will decide crystalloid vs. colloid based on the amount of chest tube drainage, urine output, and labs (i.e. Hgb/Hct). Say I've also got a CABG whose filling pressures are pretty good ( PAD of 17, CI 2.4, CVP 10) but they're still very dilated (pressure is still in the 80s) and their SVR is only about 450 after quite a bit of volume replacement, they're going to start a pressor.

Up Vote Up Vote ×
+ Join the Discussion