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Pacing Swan-Ganz Catheter

Throughout my training, I’ve placed countless pulmonary artery (“Swan-Ganz”) catheters for cardiothoracic surgeries and in the ICU to help guide the diagnosis and response to therapy in mixed or undifferentiated shock. These PA catheters gave me various pressures (central venous, pulmonary artery, sometimes right ventricular), the ability to draw true mixed venous gas samples, and a continuous cardiac output (CCO).

I’ve also had the opportunity to place a special kind of PA catheter – the pacing Swan. There are many ways to “pace” the heart – endocardial wires (as seen with pacemakers), epicardial wires (often placed after cardiac surgery), tranvenous wires, transcutaneously (please provide some sedation!), and even via the transesophageal route.

Sometimes during cardiac surgery when it’s technically challenging to place an aortic cross clamp and epicardial wires, the surgeon may elect to perform hypothermic fibrillatory arrest for myocardial protection rather than the conventional cardioplegic arrest. Fibrillation prevents the heart from ejecting blood and allows the surgeon to operate in a relatively “motionless” field while coronary perfusion is maintained.

As a cardiac anesthesiologist, I can facilitate this process with a pacing Swan. These devices are “floated” into the pulmonary artery much in the same way I place traditional Swan-Ganz catheters with transesophageal echocardiography (TEE) and/or pressure transduction; however, the pacing variant has additional ports that can provide atrial pacing, ventricular pacing, or A-V sequential pacing in addition to cardiac output measurements with the thermodilution technique. Once the catheter is properly positioned, I simply connect the ventricular lead to a pulse generator, and bam, ventricular fibrillation!

Drop me a comment below with questions! šŸ™‚

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2 Comments

  1. Hi, dr. Rishi
    How does it get into pulmunary artery?
    How do you know it’s not coiling as you advance?
    How you going to know whether this truly pulmunary artery or whether is blow up?

    Be blessed
    Luz sapnu

    1. A small balloon at the tip is inflated allowing the catheter to be carried along with the blood flow into the right atrium -> right ventricle -> and then pulmonary artery. It often times DOES coil, so experience is important. Also, I can sometimes see the catheter coiling in the right atrium or right ventricle with transesophageal echocardiography (TEE).

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