36013 Introduction of catheter, right heart or main pulmonary artery

Name of the Procedure:

Introduction of catheter, right heart or main pulmonary artery

• Common names: Right heart catheterization, Pulmonary artery catheterization
• Technical term: Swan-Ganz catheterization

Summary

Right heart catheterization is a procedure in which a long, thin tube (catheter) is inserted into a vein and guided to the right side of the heart and main pulmonary artery. It allows doctors to measure pressures in the heart and lungs, assess heart function, and evaluate the effects of certain medications.

Purpose

This procedure is used to diagnose and monitor:

• Heart failure
• Pulmonary hypertension
• Congenital heart defects
• The effectiveness of certain medications and treatments Goals of the procedure include obtaining accurate measurements of heart and pulmonary artery pressures, assessing cardiac output, and aiding in the diagnosis and management of heart and lung conditions.

Indications

• Symptoms of heart failure, such as shortness of breath, fatigue, and swelling
• Suspected pulmonary hypertension
• Unexplained fluid buildup in the body
• Assessment prior to heart surgery or certain cardiac procedures
• Monitoring the effects of heart failure treatments

Preparation

• The patient may be instructed to fast for several hours prior to the procedure.
• Certain medications might need to be adjusted or temporarily stopped.
• Blood tests and imaging studies like echocardiograms may be performed to assess overall health and plan the procedure.

Procedure Description

1. The patient is positioned on a procedure table and connected to monitoring equipment.
2. Local anesthesia is applied to the site where the catheter will be inserted, usually in the neck or groin.
3. A catheter is inserted into a vein and carefully guided to the right side of the heart and into the pulmonary artery using fluoroscopy (live X-ray).
4. Pressure measurements are taken and blood samples may be collected to analyze oxygen levels.
5. The catheter is then removed, and pressure is applied to the insertion site to stop any bleeding.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

Right heart catheterization is usually performed in a hospital's catheterization lab (cath lab) or an operating room.

Personnel

• Interventional cardiologist or specialist trained in catheterization
• Nurses
• Radiologic technologists
• Anesthesiologist or sedation nurse (if sedation is used)

Risks and Complications

• Bleeding or bruising at the catheter insertion site
• Infection
• Arrhythmias (irregular heartbeats)
• Damage to blood vessels or heart structures
• Rarely, complications like heart attack or stroke

Benefits

• Accurate diagnosis of heart and lung conditions
• Improved management of heart failure
• Guidance for appropriate treatment strategies Expected benefits are typically realized immediately after the procedure, with clearer insights into the patient's heart and lung function.

Recovery

• Patients might need to lie flat for a few hours post-procedure to prevent bleeding.
• Vital signs are closely monitored.
• Most patients can go home the same day or the next day, depending on their overall condition and the results.
• Follow-up appointments may be scheduled to discuss the findings and adjust treatment plans as necessary.

Alternatives

• Non-invasive imaging techniques like echocardiography or MRI
• Blood tests and other diagnostic evaluations While non-invasive methods carry fewer risks, they may not provide the same level of detailed information as right heart catheterization.

Patient Experience

During the procedure, the patient may feel pressure or mild discomfort at the catheter insertion site but should not experience significant pain. Post-procedure, some soreness or bruising may occur at the insertion site. Pain is usually managed with over-the-counter pain relievers, and patients are encouraged to rest and avoid strenuous activity for a few days.