Right heart catheterisation
Indications
Pulmonary hypertension
Valvular disease
Unexplained shortness of breath
Transplant workup
Post transplant care
shunt quantification
Complications
Blood clots
Air embolism
Infection
Death (rare)
Tamponade (rare)
Allergies
Bleeding – groin (low risk as veinous access)
Radiation burn
Induction of arrhythmia
Procedure
Step by step
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Puncture/Needle to skin at site of interest (local anaesthetic)
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Typically brachial or femoral vein
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Sheath inserted into vein
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Catheter inserted into the IVC and pressures are collected from the pulmonary artery (PA), pulmonary capillary wedge (PCW- which reflects the left atrial (LA) pressure), RV and RA (in any order)
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Cardiac outputs may be taken
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blood samples may be taken for saturation levels
Critical points
Needle to Skin/sheath pull and pressing on groin
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Vagal reactions -> ↓BP, ↓HR, AV block
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Cardiac outputs
What cardiac output is
Cardiac output is the amount of blood the heart pumps in 1 minute
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Is dependent on heart rate, contractility, preload, and afterload
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Normal ranges​
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Normal range: 4-8L per minute​
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Normal resting is ~5L per minute​
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Normal with exercise is ~20-40L per minute
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Causes of abnormal may be due to
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heart failure / poor heart function (low)
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severe infections (sepsis) (low or high)
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hyperthyroidism (high)
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anemia (high)
How cardiac output is calculated
Thermodilution
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A volume of cold water is injected into the right heart and the change is catheter temperature is calculated as the saline mixes with the blood.
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This is the used to calculate the blood flow, or the CO.
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Fick
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Asseses oxygen consumption and the difference in arteriovenous oxygen
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Arterial and venous blood contents are calculated using the equation:
Blood oxygen content = Hgb (g/dL) × 1.31 (mL/g) × Measured O2 saturation
Equipment
A 6F or 7F sheath is used
A 6F or 7F right heart catheter is used.
-This may be a 6F Arrow catheter or
-A 7F Swan Ganz catheter (if cardiac outputs are required)
