The Basics of the Pulmonary Artery Catheter with Dr. Aniket Rali
SoCCC Pre-Rounds: Bite-Sized Critical Care Cardiology Topics Delivered By Experts
Special Cases: LBBB and Pacemaker Leads
Aniket discusses relative risks with left bundle branch block and fresh pacemaker leads and recommends image guidance when needed.
Did you know that pulmonary artery catheters are crucial for patients with unclear shock etiology? In this episode of SoCCC Pre-Rounds, Dr. Elliot Miller sits down with Dr. Aniket Rali, a dual-trained critical care and heart failure cardiologist at Vanderbilt, for a deep dive into the art and science of pulmonary artery catheterization, also known as the Swan-Ganz catheter.
Dr. Rali demystifies the PAC by walking us through the fundamentals of when to use it, who should not get one, and how to interpret and troubleshoot the data it provides. Whether you're a resident inserting your first swan or a fellow refining your hemodynamic assessments, this episode will elevate your bedside practice.
From contraindications and waveform recognition to zeroing, troubleshooting, and avoiding wedge-related complications, Dr. Rali shares high-impact pearls grounded in real-world CICU experience.
Key Takeaways
Use PACs when shock etiology is unclear; they're diagnostic, not therapeutic
Avoid PACs in patients with endocarditis, thrombus, or proximal PE
Know your waveforms; it's your only guide during bedside placement
Always level and zero the transducer for accurate pressures
Justify PAC use daily and remove once it’s no longer needed
Troubleshoot waveform loss by checking positioning, clots, or tubing
Avoid repeated wedging; use diastolic-to-wedge trends when possible
Use chest X-ray to confirm safe placement and prevent complications
In This Episode
[00:00] Introduction
[01:16] Pulmonary artery catheter basics
[02:04] Indications for PA catheter use
[06:57] Special considerations: left bundle and pacemaker leads
[08:12] Bedside placement preparation and checklist
[11:33] Presenting PA catheter data on rounds
[12:03] Ensuring data accuracy and daily safety checks
[15:17] Sequence for presenting hemodynamic data
[16:23] Cardiac output measurement methods
[18:31] Choosing between Fick and thermodilution
[20:04] Limitations in shunt physiology
[20:58] Troubleshooting PA catheter issues
Notable Quotes
[02:17] "At the end of the day, a diagnostic tool is not going to treat your patient. But if it provides you with additional information that helps you reach the right diagnosis, then it becomes a valuable tool." — Dr. Aniket Rali
[09:07] "I firmly believe that the more you sweat in peace, less you bleed in war. And that holds true of any procedure." — Dr. Aniket Rali
[10:07] "You really should not be putting in a bedside swan unless you have mastered the waveforms, because the waveforms are your only guidance as to which cardiac chamber you are in." —Dr. Aniket Rali
[12:31] "I encourage trainees, next time they have a patient with a SWAN Ganz catheter in, to just have them move their arm or move the catheter up by a foot and down by a foot and see how the pressure readings change." — Dr. Aniket Rali
[27:28] "Long live the swan." — Dr. Aniket Rali
Dr. Aniket Rali
Dr. Aniket Rali is a heart failure and critical care cardiologist at Vanderbilt University. She’s known for her expertise in hemodynamics, real-world application of advanced monitoring, and thoughtful mentorship of trainees learning the art of bedside right heart catheterization.
Resources and Links
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Dr. Aniket Rali
Dr. Elliot Miller
Supported By:
This episode is made possible by unrestricted support from Zoll LifeVest — thanks for keeping high-impact education free for our community.
Disclaimer
This podcast is not medical advice, just candid, practical discussions about what your hosts do every day in the CICU. Always consult your supervising team and current guidelines before applying any interventions.
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