Swan Ganz Catheter Setup

Stroke Volume 1cc/kg/heart beat

• example 70kg man
• 1cc/kg = 70cc/heart beat

Cardiac Output = SV x HR 

• example: 70 kg man with HR of 60/min
• Cardiac Output = (70 x 1) x 70 = 4.9 L/min

Cardiac Index = CO/Body Surface Area

• example 4.9L /min /1.25 m2 = 3.6 L/min/m2
• recall that the average BSA for woman is 1.6m2 and 1.9m2 for men

Normal CVP = 2-6 (with many caveats in the ICU)

Normal PA Pressure = 20-30/8-12 (with many caveats in the ICU)

Normal PCWP = 4-12 (wiith many caveats in the ICU)

Normal PVR = 37 - 250 dynes/sec/cm5

Normal SVR = 800-1200 dynes/sec/cm5

Normal RV Pressure = 20-30/0-5 mmHg

• unlike echo, it provides more than a snap shot in time (continuous monitoring

• safe and easy to do in the right hands

• extremely useful for targeted therapy in cardiogenic shock and can be very usefull in mixed shock as well

Technical

• it is dependent upon thermodilution

• Temperature of the injectate must  be consistent between measuremen

• Volume of the injectate mustbe consistent between measurements

• Concurrent infusion of IV fluids (underestimates CO)

Cardiac Abnormalities

• patients with intracardiac shunts may have falsely low numbers

• Patients with tricuspid regurge may have falsely low numbers

Trying to normalize values

• Clinicians will try to normalize values but in some patients with underling cardiac disease who can't rise to the occasion, this approach can be harmful

Misinterpretation of numbers

• This too can be harmful as it results in incorrect targetted thearpy

• Central line complications

• Pulmonary artery rupture

• Ruptured balloon/Air embolism

• Knotting of the catheter

• Damaged valves (pulling back with balloon inflated)

• Catheter clots

• Catheter infections