Right heart catheterization (RHC) is a minimally invasive diagnostic procedure that provides physicians with direct, real-time information about the function and pressures within the heart and lungs. This technique involves inserting a thin, flexible catheter into a vein and guiding it into the right side of the heart. The goal of an RHC is to gather precise physiological data to evaluate the heart’s pumping efficiency and assess the circulatory system that moves blood to the lungs. RHC is used to diagnose and manage complex cardiopulmonary diseases.
Why Doctors Use Right Heart Catheterization
RHC is considered the definitive method for accurately measuring pressures within the chambers on the right side of the heart and the major blood vessels connecting to the lungs. Specifically, the procedure records pressures in the right atrium, the right ventricle, and the pulmonary artery, which is the main vessel carrying deoxygenated blood to the lungs. By obtaining a pulmonary capillary wedge pressure, physicians can also gain an indirect assessment of the pressure in the left side of the heart, which is otherwise difficult to measure directly from this approach.
Beyond pressure measurements, RHC is used to calculate the cardiac output (the volume of blood the heart pumps per minute). This information is combined with pressure data to calculate the pulmonary vascular resistance (the measure of resistance to blood flow through the lungs). This comprehensive set of hemodynamic data is foundational for diagnosing several serious conditions. This includes confirming the presence and severity of pulmonary hypertension, which is high blood pressure in the lung arteries.
The procedure is also used in assessing the severity of heart failure and helping to distinguish between different types, such as left-sided versus right-sided dysfunction. RHC guides treatment for patients experiencing various forms of shock by monitoring the response to medications and fluid management. This technique is sometimes referred to as a pulmonary artery catheterization or, historically, a Swan-Ganz catheterization, after its inventors.
What to Expect During the Catheterization Procedure
Preparation for RHC typically begins with instructions to fast for six to twelve hours before the procedure. Patients are advised to discuss all current medications with their care team, as some, such as blood thinners, may need to be temporarily stopped or adjusted. Upon arrival at the hospital or cardiac catheterization laboratory, the patient changes into a gown. Small patches called electrodes are placed on the chest to monitor the heart’s electrical activity throughout the procedure.
The procedure itself usually lasts about an hour, though the entire process, including preparation and recovery, may take several hours. The patient is positioned on a table, and a mild sedative is often administered intravenously to promote relaxation, though the patient remains awake and able to follow instructions. The medical team cleans and shaves the area where the catheter will be inserted, which is typically a vein in the neck, groin, or arm.
A local anesthetic is then injected to numb the insertion site, which may cause a brief stinging or burning sensation. Once the area is numb, the physician makes a small puncture and inserts a short, hollow tube called an introducer sheath into the vein. The actual catheter is then threaded through this sheath and carefully advanced, using X-ray guidance, through the major veins into the right atrium, the right ventricle, and finally into the pulmonary artery.
The patient may feel a sense of pressure when the sheath or catheter is inserted, but there should be no pain as the procedure takes place within the blood vessels. Once the catheter is in the pulmonary artery, the necessary pressure readings and blood samples are taken to complete the diagnostic evaluation. After all measurements are recorded, the catheter and the introducer sheath are removed, and firm pressure is applied to the insertion site to prevent bleeding.
Recovery and Follow-Up Care
Immediately following the procedure, the patient is moved to a recovery area for a period of observation. If the catheter was inserted via the groin, the patient must lie flat for several hours to allow the puncture site to seal properly and minimize the risk of bleeding. Patients who had the catheter placed in the arm or neck may have fewer positional restrictions but are still monitored closely.
During the recovery period, nurses frequently check vital signs and examine the insertion site for any signs of bleeding, swelling, or hematoma formation. Because a sedative is administered, a responsible adult must drive the patient home. For the following 24 hours, the patient should avoid driving, operating machinery, or making important decisions. Strenuous activity, such as heavy lifting, is restricted for at least a few days to a week, depending on the physician’s instructions and the insertion site.
The care team provides specific instructions for managing the puncture site, which usually involves keeping the area clean and dry. Most patients are advised to avoid soaking the site in a bath, hot tub, or pool for about a week, though showering is generally permitted after 24 to 48 hours. The physician will typically discuss the initial findings and the next steps for treatment with the patient before discharge.