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The passage of a catheter (a thin flexible tube) into the right side of the heart to obtain diagnostic information about the heart and for continuous monitoring of heart function in critically ill patients.

How the Test is Performed

The test can be performed at the bedside in a critical care unit, radiology department, special procedures room, or cardiac procedures laboratory. A mild sedative is given prior to the test. An intravenous line is started in an arm to allow for the administration of medication during the procedure.

A radiologist or cardiologist inserts the catheter through a venipuncture or a small incision in a vein in the arm, neck, or groin after cleansing the site and numbing the site with a local anesthetic. The catheter is then carefully threaded into the heart.

The catheter enters the right atrium, flows through the tricuspid valve into the right ventricle, through the pulmonary valve, and into the pulmonary artery. The pressures in the pulmonary artery can be used to indirectly measure the function of the left ventricle.

The position of the catheter within the heart is confirmed by a chest X-ray or by fluoroscopy during the procedure, and by monitoring devices that also read the pressures within the heart. During the procedure, the heart's rhythm is monitored continuously by electrocardiogram.

How to Prepare for the Test

Adults:
Food and fluid are restricted for 6 to 8 hours before the test, if possible. Sometimes, admission the night before the test is required. Otherwise, admission as an outpatient or inpatient the morning of the procedure is required if the procedure is elective. In critically ill patients, the test may be carried out in the intensive care unit. A health care provider must explain the procedure and its risks. A witnessed, signed consent for the procedure is required. A mild sedative is usually given 1/2 hour before the procedure. Hospital clothing is worn.

Infants and children:
The physical and psychological preparation you can provide for this or any test or procedure depends on your child's age, interests, previous experience, and level of trust. For specific information regarding how you can prepare your child, see the following topics as they correspond to your child's age:

infant test or procedure preparation (birth to 1 year)
toddler test or procedure preparation (1 to 3 years)
preschooler test or procedure preparation (3 to 6 years)
schoolage test or procedure preparation (6 to 12 years)
adolescent test or procedure preparation (12 to 18 years)

How the Test will Feel

Sedation is given to relax the patient prior to the procedure, but the patient is awake and able to follow instructions during the test. The patient will remain on a stretcher or bed for the duration of the test. An insertion is made into a vein for threading the catheter into the heart. Local anesthesia is given to insert the catheter, and the only sensation is one of pressure at the site.

Discomfort may arise from having to lie still for prolonged periods of time. The procedure may last up to 1 hour, and in critically ill patients, the catheter may remain in place for several days for monitoring.

Why the Test is Performed

The procedure is performed to evaluate:

circulatory volume (in heart failure, shock, acute valvular regurgitation, congenital heart disease, burns, or renal disease)
monitor for complications of acute myocardial infarction
monitor effects of certain cardiovascular drugs.

Swan-Ganz catheterization can be used to detect shunt (i.e., abnormal blood flow between 2 usually unconnected areas). Conditions that can also be diagnosed or evaluated with S-G catheterization include pulmonary hypertension, cardiac tamponade, and restrictive cardiomyopathy.

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