Source: Thrive Global
I used to love “swanning” my patients — — until I realized I was hurting them.
The Swan Ganz Catheter, or “Swan,” was introduced in 1970 as a new way to measure pressures inside the heart and lungs. These numbers would, in theory, be helpful to an ICU physician like myself, trying to maneuver her patient through the physiologic onslaught of shock.
These pressures are hidden in the fragile recesses of the heart, and until the Swan’s debut, were accessible only to interventional cardiologists whose sharp-tipped catheters could easily puncture the wall of the heart, resulting in immediate death. But the Swan’s tip was encased in an inflatable balloon that allowed it to float more safely through the chambers of the heart, and ICU physicians quickly became emboldened to go where only cardiologists had gone before. Placing a Swan became so common that the procedure was honored with its own verb in medicalese. At the height of its use, the catheter was routinely being inserted in 20–40% of all ICU patients, and accounted for 2 billion dollars in Medicare payments annually.
The procedure was almost a religious experience. We prepped the patient’s neck, the only body part left visible, with three rounds of betadine swabs. The sterile kit was unwrapped and waiting on the bedside table, needles lined up, syringes filled with lidocaine and saline. As we threaded the catheter in, the monitor beeped with every heartbeat to alert us to any dangerous change in rhythm. It displayed the pressure readings, waves rising and falling as the catheter crossed from the superior vena cava into the right atrium of the heart, then into the right ventricle, and eventually into the pulmonary artery, where it would be parked for days, sometimes longer.
But the Swan was dangerous, often triggering arrhythmias or damaging delicate tissue. And, as it eventually turned out, it didn’t help patients at all. (…) Read Full Article Here