Right Heart Catheterization and Endomyocardial Biopsy

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  • Determine hemodynamic status (volume status [RA and PAW pressures], PA pressures and pulmonary vascular resistance, cardiac output, and systemic vascular resistance) in a variety of clinical settings:
    • Etiology of hypotension (e.g., volume depletion, low cardiac output, and/or low systemic vascular resistance)
    • Anticipated need for, or ongoing monitoring of response to, vasoactive agents (including inotropes, vasoconstrictors, and/or vasopressors)
    • Determining PA pressures and pulmonary vascular resistance
    • Preoperative evaluation for solid organ transplantation where index of suspicion for elevation in PA pressures and/or pulmonary vascular resistance is high
    • Identifying altered hemodynamic states that may indicate cardiac rejection in patients after cardiac transplantation
  • There are no absolute contraindications.
  • Relative contraindications include the following:
    • Coagulopathy
    • Refractory arrhythmia
    • Active gastrointestinal tract bleeding
    • Pregnancy
    • Inability of patient to cooperate
    • Active infection
    • Renal failure
  • Sterile mask, cap, gown, gloves
  • Sterile sheet over patient
  • Crash cart with resuscitation equipment and defibrillator
  • One percent lidocaine
  • Twenty-five- to 30-gauge needle and syringe for local anesthesia
  • “Micropuncture” kit with 21-gauge needle with guidewire and 5-French dilator
  • Venous introducer sheath (various French sizes, typically 8- or 9-French) with J-tipped wire
  • PA catheter
  • Right or left internal jugular vein
    • Alternative vascular access sites (e.g., right or left femoral vein) can be used.

Sample excerpt does not include step-by-step text instructions for performing this procedure
The full content of this section includes:
  • Step-by-step text instructions for performing the procedure
  • Clinical pearls providing practical clinical tips from medical experts
  • Patient safety guidelines consistent with Joint Commission and OHSA standards
  • Links to medical evidence and related procedures


Bed rest required only for femoral venous access, with other postcatheterization care per institutional protocol

  • Bleeding
  • Vascular injury (e.g., carotid artery puncture)
  • Air embolism
  • Arrhythmia
  • Cardiac arrest
  • Death
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