Prospective Study of Pulmonary Artery Balloon Floatation Catheter Insertions

Abstract

All Swan-Ganz catheter insertions over a 6-month pe riod were examined prospectively to determine current patterns of utilization, details of insertion, and the na ture, severity, and frequency of complications. There was an attempt to insert a Swan-Ganz catheter on 169 occasions in 153 patients with an eventual success rate of 95%. Catheterizations were classified as medical (82) or surgical (87). Medical patients were more acutely ill, required longer insertion time for venous cannulation (9.6 ± 7.7 min versus 8.1 ± 9.2 min;p < 0.01), needed their catheters for a longer period of time (90 ± 89 hours versus 64 ± 59 hours; p < 0.05), and had a poorer hospital survival (46% versus 86%; p < 0.05). There were no complications either during or following insertion in 45% of procedures or 50% of patients. There were 14 major complications in 8% of proce dures and 9% of patients; the most serious were com plex ventricular dysrhythmias, which accounted for the death of one patient. Most of the complications were minor and of no consequence to the patient. We con clude that Swan-Ganz catheterization, performed by a variety of operators in high-risk patients, provides reli able measurements over a long period of time with an acceptable frequency of major complications.

The pulmonary artery balloon floatation catheter (Swan-Ganz catheter), which permits the measure ment of blood pressure and flow as well as mixed venous blood oxygen saturation, is widely used in the investigation and management of patients with a variety of medical and surgical illnesses accom panied by hemodynamic derangements. In seri ously ill patients, major complications might be an ticipated if medical personnel lacked the necessary skills and experience to undertake an invasive pro cedure and to employ sophisticated technology. Al though many case reports exist, there are few pro spective studies that delineate the frequency and severity of such complications.

The purpose of this study was to examine pro spectively all Swan-Ganz catheter insertions in a busy community-based, acute care university teach ing hospital with housestaff. The intent was to out line current patterns of utilization and details of the insertions and, within this context, to determine the nature, severity, and frequency of complications oc curring during insertion as well as the subsequent clinical course of patients receiving Swan-Ganz catheters.