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Simple, rapid method for insertion of a Swan-Ganz catheter using an existing central venous or Swan-Ganz catheter
Simple, Rapid Method for Insertion of a Swan-Ganz Catheter Using an Existing Central Venous or Swan-Ganz Catheter
Dennis A. Fried, MD, Cleveland, Ohio James L. Berk, MD, Cleveland, Ohio
Recent advances in intensive care monitoring have greatly expanded our ability to care for critically ill patients. A most useful device for evaluating cardiac function is the Swan-Ganz flow-directed pulmonary artery catheter [1,2]. Because of the limited value of central venous pressure for assessing left ventricular function, and because of the necessity of replacing existing Swan-Ganz catheters due to mechanical failures and possible infections, a simple, rapid method for replacing a central venous pressure catheter or existing Swan-Ganz catheter with a new Swan-Ganz catheter was devised.
catheter already in place is withdrawn (with the balloon deflated) so that the 30 cm mark is at skin level. The catheter is then divided at the 35 to 40 cm mark using a scalpel or scissors. A view of the cut end (Figure 1) reveals four channels, one of which contains the thermistor wires with the channel diagonally opposite representing the puhnonary artery channel. This channel will accept an 0.025 inch, 70 cm guide wire (USC1 no. 007004) which is inserted for approximately 35 cm. The Swan-Ganz catheter remnant is then withdrawn over this wire and a no.
Technique Placement of a Swan-Ganz catheter Through an Existing Central Venous Pressure Catheter. A
percutaneous catheter introducer set (USCI, Billerica, Massachusetts, no. 008888) is used. The 0.038 inch guide wire from the set is inserted into the ex-, isting (no. 16-F or larger) central venous pressure catheter. The catheter is withdrawn leaving in place the guide wire, which is now used to accept the dilator-introducer unit. Removal of the wire and dilator leaves the introducer in place and a no. 7 French thermistor-equipped Swan-Ganz catheter (Edwards Laboratories 93A-131-7F) is then inserted. Replacement of an Existing Swan-Ganz Catheter With a New Swan-Ganz Catheter. The Swan-Ganz From the Departments of Surgery, Case Western Reserve University School of Medicine, and Metropolitan General Hospital, Cleveland; and Akron City Hospital, Akron, Ohio. Reprint requests should be addressed to Dennis A. Fried. MD, Departmant of Surgery, Akron City Hospital, Akron, Ohio 44309.
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Figure 1. A, thermistor wires; B, pulmonary artery channel; C, distal end of Swan-Ganz catheter.
The American Journal of Surgery
Simple, Rapid Swan-Ganz Catheter Insertion
16 or larger, 8 inch central venous pressure catheter (Desseret no. 3162) is advanced over the wire and into position. The 0.025 inch guide wire is removed and the technique described in the first paragraph in this section is then followed using the 0.038 inch guide wire (too large to pass through the Swan-Ganz catheter remnant) that is contained in the introducer set. This technique has been used numerous times in the surgical intensive care unit without incident and has saved considerable time in establishing and maintaining these invaluable monitoring devices in our patients.
Volume 139, March 1980
Summary
A method is described for simple, rapid SwanGanz catheter insertion. In addition, a new technique for replacement of Swan-Ganz catheters without the need for additional venipuncture is presented. References
1. Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283: 447-51. 2. Buchfinder N, Ganz W. Hemodynamic monitoring: invasive techniques. Anesthesiology 1976; 145: 146-55.
455
Dennis A. Fried, MD, Cleveland, Ohio James L. Berk, MD, Cleveland, Ohio
Recent advances in intensive care monitoring have greatly expanded our ability to care for critically ill patients. A most useful device for evaluating cardiac function is the Swan-Ganz flow-directed pulmonary artery catheter [1,2]. Because of the limited value of central venous pressure for assessing left ventricular function, and because of the necessity of replacing existing Swan-Ganz catheters due to mechanical failures and possible infections, a simple, rapid method for replacing a central venous pressure catheter or existing Swan-Ganz catheter with a new Swan-Ganz catheter was devised.
catheter already in place is withdrawn (with the balloon deflated) so that the 30 cm mark is at skin level. The catheter is then divided at the 35 to 40 cm mark using a scalpel or scissors. A view of the cut end (Figure 1) reveals four channels, one of which contains the thermistor wires with the channel diagonally opposite representing the puhnonary artery channel. This channel will accept an 0.025 inch, 70 cm guide wire (USC1 no. 007004) which is inserted for approximately 35 cm. The Swan-Ganz catheter remnant is then withdrawn over this wire and a no.
Technique Placement of a Swan-Ganz catheter Through an Existing Central Venous Pressure Catheter. A
percutaneous catheter introducer set (USCI, Billerica, Massachusetts, no. 008888) is used. The 0.038 inch guide wire from the set is inserted into the ex-, isting (no. 16-F or larger) central venous pressure catheter. The catheter is withdrawn leaving in place the guide wire, which is now used to accept the dilator-introducer unit. Removal of the wire and dilator leaves the introducer in place and a no. 7 French thermistor-equipped Swan-Ganz catheter (Edwards Laboratories 93A-131-7F) is then inserted. Replacement of an Existing Swan-Ganz Catheter With a New Swan-Ganz Catheter. The Swan-Ganz From the Departments of Surgery, Case Western Reserve University School of Medicine, and Metropolitan General Hospital, Cleveland; and Akron City Hospital, Akron, Ohio. Reprint requests should be addressed to Dennis A. Fried. MD, Departmant of Surgery, Akron City Hospital, Akron, Ohio 44309.
454
Figure 1. A, thermistor wires; B, pulmonary artery channel; C, distal end of Swan-Ganz catheter.
The American Journal of Surgery
Simple, Rapid Swan-Ganz Catheter Insertion
16 or larger, 8 inch central venous pressure catheter (Desseret no. 3162) is advanced over the wire and into position. The 0.025 inch guide wire is removed and the technique described in the first paragraph in this section is then followed using the 0.038 inch guide wire (too large to pass through the Swan-Ganz catheter remnant) that is contained in the introducer set. This technique has been used numerous times in the surgical intensive care unit without incident and has saved considerable time in establishing and maintaining these invaluable monitoring devices in our patients.
Volume 139, March 1980
Summary
A method is described for simple, rapid SwanGanz catheter insertion. In addition, a new technique for replacement of Swan-Ganz catheters without the need for additional venipuncture is presented. References
1. Swan HJC, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283: 447-51. 2. Buchfinder N, Ganz W. Hemodynamic monitoring: invasive techniques. Anesthesiology 1976; 145: 146-55.
455