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Right heart catheterization: Difference between revisions
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Right heart catheterization (view source)
Revision as of 17:29, 26 September 2014
, 26 September 2014→Technique
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Femoral access is associated with increased risk of local hemorrhage. When the catheter is left indwelling, the jugular or subclavian vein is preferable, because it allows the patient to sit. The jugular approach is preferred to the subclavian to lessen the risk of pneumothorax and is easiest performed ultrasound guided. The basilica or medial antibrachial vein (the continuation of the basilica in the underarm, see figure 2) can also be used, while contrast via an radial arterial sheath (for cardiac output measurement) will visualize the vein. | Femoral access is associated with increased risk of local hemorrhage. When the catheter is left indwelling, the jugular or subclavian vein is preferable, because it allows the patient to sit. The jugular approach is preferred to the subclavian to lessen the risk of pneumothorax and is easiest performed ultrasound guided. The basilica or medial antibrachial vein (the continuation of the basilica in the underarm, see figure 2) can also be used, while contrast via an radial arterial sheath (for cardiac output measurement) will visualize the vein. | ||
[[File:RightHeart_Technique_Fig2.svg | thumb | | [[File:RightHeart_Technique_Fig2.svg | thumb | left | 500px | Figure 2. Part of the venous and arterial system.]] | ||
After placement of the sheath, the flushed catheter is introduced into the vein and advanced into the inferior vena cava, superior vena cava, right atrium, right ventricle and pulmonary artery (figure 3). | After placement of the sheath, the flushed catheter is introduced into the vein and advanced into the inferior vena cava, superior vena cava, right atrium, right ventricle and pulmonary artery (figure 3). | ||
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[[File:RightHeart_Technique_Fig3.svg | thumb | left | | [[File:RightHeart_Technique_Fig3.svg | thumb | left | 500px | Figure 3. Right heart catheterization from the femoral vein<cite>Braunwald</cite>]] | ||
Top row: the PAC is placed in the right atrium aimed at the lateral wall. Counterclockwise rotation aims the catheter posteriorly and allows advancement into the superior vena cava. | Top row: the PAC is placed in the right atrium aimed at the lateral wall. Counterclockwise rotation aims the catheter posteriorly and allows advancement into the superior vena cava. | ||
Centre row: the catheter is then withdrawn into the right atrium and aimed laterally. Clockwise rotation causes the tip to cross the tricuspid valve. With the tip in a horizontal position, it is positioned below the right ventricular outflow tract. Additional clockwise rotation causes the catheter to point straight up, allowing it to advance into the pulmonary artery and from there into the right pulmonary artery. | Centre row: the catheter is then withdrawn into the right atrium and aimed laterally. Clockwise rotation causes the tip to cross the tricuspid valve. With the tip in a horizontal position, it is positioned below the right ventricular outflow tract. Additional clockwise rotation causes the catheter to point straight up, allowing it to advance into the pulmonary artery and from there into the right pulmonary artery. | ||
{{clr}} | {{clr}} | ||
=== Normal and abnormal waveforms === | === Normal and abnormal waveforms === | ||