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July 31, 2007
Pulmonary Artery Catheters
The Swan-Ganz catheter is the paragon of useless medical testing. It has taken forty years to see the beginning of the end of a technique which seemed to make good sense. Here was a way to measure central venous pressure and pulmonary artery pressure. Measurement is the heart of Cartesian/Baconian medicine. And so beautifully ironic that it measured parameters most critical to the book that first demonstrated the new Medicine, Harvey's Circulation. The Swan-Ganz (PA catheter) was the very definition of critical care when I was training.
The JAMA article in 1990 revealed that many of us did not understand even some of the basic concepts involved. Other studies demonstrated increased mortality, or no benefit.
This week's JAMA has a study of the declining use, as well as two editorials on the S-G. One summarizes, "The 40-year story of the PA catheter is nearing its end. It is a cautionary tale of rapid adoption and slow evaluation of a monitoring device that, when used correctly, provides exquisitely detailed physiological data that, regrettably, does not appear to benefit patients. Older clinicians will look back wistfully on the hours spent placing, troubleshooting, and debating the data from the PA catheters. Younger colleagues will just wonder what all the fuss was about."
Excellent summary. And how many other procedures in medicine will fall on the same sword? Many, I would guess.
| By Robert Maddox | 11:35 PM