93503 Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring purposes

Name of the Procedure:

Insertion and placement of flow-directed catheter (eg, Swan-Ganz catheter)

Summary

The insertion and placement of a flow-directed catheter, commonly known as a Swan-Ganz catheter, involves threading a specialized device through a large vein into the heart to monitor heart function and blood flow. This minimally invasive procedure helps doctors evaluate and manage critically ill patients.

Purpose

This procedure is used to:

• Measure heart function and blood flow.
• Diagnose heart conditions and monitor the effectiveness of treatments for heart disease.
• Assess fluid status in critically ill patients.

Indications

• Severe heart failure
• Shock (cardiogenic, septic, or hypovolemic)
• Pulmonary hypertension
• Major surgery requiring close cardiac monitoring
• Patients undergoing treatments that can significantly impact cardiovascular status

Preparation

• Patients may need to fast for several hours before the procedure.
• Certain medications may need to be adjusted or stopped.
• Routine diagnostic tests such as blood tests, ECG, and chest X-ray may be required beforehand.

Procedure Description

1. The patient is usually sedated and placed in a supine position.
2. An insertion site, typically in the neck, arm, or groin, is sterilized and numbed with a local anesthetic.
3. A large vein is accessed using a needle and a guidewire, followed by the insertion of a catheter sheath.
4. The Swan-Ganz catheter is threaded through the sheath, guided through the vein to the heart, and into the pulmonary artery.
5. The catheter's position is confirmed using fluoroscopy or pressure waveforms.
6. The catheter allows for continuous monitoring of heart pressures and blood flow.

Duration

The procedure generally takes about 30 minutes to an hour.

Setting

Hospital, usually in a cardiac catheterization lab or ICU.

Personnel

• Cardiologist or Intensivist
• Cardiac nurse
• Radiology technician
• Anesthesiologist (if deep sedation is used)

Risks and Complications

• Infection at the insertion site
• Bleeding or hematoma formation
• Pneumothorax (collapsed lung)
• Arrhythmias (irregular heartbeats)
• Pulmonary artery rupture (rare but serious)

Benefits

• Accurate and real-time information on heart function and blood pressure
• Helps guide treatment decisions for critically ill patients
• Can improve patient outcomes by enabling tailored medical interventions

Recovery

• Patients are monitored closely for a few hours after the procedure.
• Follow instructions regarding activity restrictions to prevent complications.
• Follow-up appointments or interventions may be needed based on initial findings.

Alternatives

• Non-invasive cardiac output monitoring
• Echocardiography
• Central venous pressure monitoring
• Each alternative varies in reliability, risk, and the type of information provided.

Patient Experience

• Patients might feel slight discomfort or pressure during the numbing injection.
• The majority of the procedure is performed under sedation, so patients may not be fully aware.
• Mild soreness at the insertion site can be managed with pain relievers.