Pulmonary artery catheterization: Interpretation of hemodynamic values and waveforms in adults
- Frank E Silvestry, MD
Frank E Silvestry, MD
- Associate Professor of Medicine
- Hospital of the University of Pennsylvania
The pulmonary artery catheter (PAC; Swan-Ganz or right heart catheter) can be used for a variety of clinical purposes. Interpreting hemodynamic data from PACs is important for the diagnosis and management of a range of conditions including shock and pulmonary artery hypertension (table 1).
The interpretation of hemodynamic values and pressure tracings derived from the PAC is described in this topic. The insertion technique, indications, contraindications, and complications of PACs are discussed separately. (See "Pulmonary artery catheters: Insertion technique in adults" and "Pulmonary artery catheterization: Indications, contraindications, and complications in adults".)
Direct measurements of the following can be obtained from an accurately placed pulmonary artery catheter (PAC):
●Central venous pressure (CVP)
●Right-sided intracardiac pressures (right atrium, right ventricle)
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- PHYSIOLOGIC MEASUREMENTS
- ENSURING ACCURATE MEASUREMENTS
- Zeroing and referencing
- Correct placement
- The "fast flush" test
- CATHETER WAVEFORMS AND PRESSURES
- Right atrium (RA)
- - Elevated RA pressure
- - Abnormal RA waveforms
- Right ventricle
- Pulmonary artery
- Pulmonary artery occlusion pressure (PAOP)
- - Abnormal PAOP
- - Abnormal PAOP waveforms
- - Sources of error
- Discordant PAOP and LV end-diastolic pressure
- Lung zone misplacement
- Respiratory effects
- Positive end-expiratory pressure
- CALCULATION OF CARDIAC OUTPUT
- Indicator thermodilution method
- Fick method
- DETECTION OF LEFT-TO-RIGHT SHUNTS
- SYSTEMIC AND PULMONARY VASCULAR RESISTANCE
- SUMMARY AND RECOMMENDATIONS