Abstract
SINCE its introduction in 1970,1 the flow-directed balloon-tipped (Swan-Ganz) catheter has gained clinical acceptance and increased usage for continuous monitoring of the hemodynamic status of severely ill patients. The clinical diagnosis of deep-vein thrombosis has been shown to be unreliable,4 and no systematic evaluation of this phenomenon has been undertaken. [...]we initiated a prospective study to determine, by angiography, the incidence of internal jugular-vein thrombosis in 33 consecutive critically ill patients who required temporary monitoring with Swan-Ganz catheters via the internal jugular vein. Fifteen patients in Group 2 (as compared with eight in Group 1) were treated with heparin infusion, but nevertheless evidence of deep-vein thrombosis developed. [...]we conclude that venous thrombosis is a frequent complication of temporary monitoring with the Swan-Ganz catheter, especially in patients whose circulatory function has been impaired for a prolonged period. Recently, the percutaneous trans-internal jugular-vein approach has been advocated6, 7 as providing the shortest and most direct route to the right atrium, with very low rates of initial technical complications and episodes of late sepsis. [...]experience with long-term venous cannulation for hyperalimentation has suggested that direct introduction of a catheter into a high-flow, large-bore vein decreases septic and thrombotic complications.8 In contrast, it is well known that intravascular catheters may become covered with thrombotic material; Hoar et al. have recently emphasized the occurrence of this problem with the Swan-Ganz catheter.9 Massive thrombus formation secondary to Swan-Ganz catheterization was noted in a post-mortem examination of one patient who underwent prolonged catheterization.10 Dye et al.11 reported thrombosis of the jugular and subclavian veins in one patient, and thrombosis of the superior vena cava in another patient, after insertion of a Swan-Ganz catheter by means of right antecubital cutdown.