Critically ill patients in an intensive care unit often present physicians with a diagnostic challenge. It can be difficult to ascertain why the heart, lungs or kidneys are not functioning normally. It may be difficult to know why a patient's blood pressure is low. Another critical piece of information is the patient's fluid balance-whether they are dehydrated or over-hydrated.

When other diagnostic means fail, the physician may place a pulmonary artery catheter-a device developed by two doctors named Swan and Ganz.

This is placed in the intensive care unit. After receiving a local anesthetic, the catheter is placed through the skin into a vein. This can be a vein under the collar bone, a vein in the neck, or a vein in the arm or leg. The catheter is essentially a long, thin plastic tube that contains multiple channels within it.

The catheter is then advanced through the vein and through the right sided heart chambers and into the pulmonary artery. It is usually left in place for 1 to 3 days, depending on the patient's clinical situation. It gives valuable information about the pumping ability of the heart and the pressure within the chambers of the heart which can help solve the diagnostic dilemma mentioned above as well as guide further therapy.

They are sometimes placed in the operating room to help monitor the heart during and following surgery-both cardiac and noncardiac surgery.

They are also sometimes placed during a diagnostic angiogram to help evaluate heart failure, valve disease and pericardial disease.

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