Hemodynamic instability is a prevalent and severe issue in the Intensive Care Unit (ICU). It often leads to catastrophic complications such as organ failure, shock, and increased mortality rates, demanding diligent monitoring and resource allocation, and resulting in significant per-patient economic burdens. A fundamental challenge faced in the ICU today is the lack of steering capabilities in the distal tip of currently available Swan-Ganz pulmonary artery (PA) catheters.
The pulmonary artery carries de-oxygenated blood from the right heart to the lungs. PA catheters are inserted into a large neck vein and fed into the pulmonary artery to estimate right-sided heart pressures. The balloon tip can be inflated and wedged into a smaller pulmonary artery to predict left-sided heart pressures. These values help determine treatment for severe illness such as end-stage heart failure, kidney failure, and pulmonary hypertension.
PA catheters are easily dislodged by movement of the patient or simply by their mobile beating heart. Particularly dangerous mispositioning can lead to fatal cardiac arrythmias and vessel wall rupture, a lethal complication with 50% mortality. The current method of repositioning PA catheters involves pulling or pushing the catheter from the neck site, monitoring pulmonary artery pressure waveforms during systole (heart contraction) and diastole (heart relaxation), and obtaining a chest x-ray to confirm correct positioning.
The inherent limitation of blinding repositioning by hand can create difficulties, such as when the catheter tip lies against a vessel’s wall. Consequently, this lack of maneuverability necessitates further manual manipulation of the catheter, exposing the patient to additional radiation for the confirmation of the catheter position after the adjustment. At times, even complete catheter exchange becomes unavoidable. These manipulations are also not without risk, as they increase the potential for infection, bleeding, and trauma.
In the current technological landscape, no innovative solutions have been designed to specifically address these physical limitations of pulmonary artery catheters in the ICU. The focus has primarily been on refining the interpretation of hemodynamic data and predictive algorithms, leaving the hardware shortcomings unattended.
We propose to challenge this status quo by enhancing the Swan-Ganz pulmonary artery catheter with a steerable distal tip. This design would allow precise adjustments to the catheter’s tip position even after initial placement, potentially improving the accuracy of parameter measurements and reducing complications. Importantly, our adaptation aims to enhance the functionality of the Swan-Ganz catheter without significantly increasing the cost.
With its transformative potential, this enhanced Swan-Ganz catheter could redefine ICU care by revolutionizing hemodynamic monitoring, expediting patient stabilization, shortening ICU stays, and cutting costs. If successful, it stands to globally revolutionize ICU hemodynamic monitoring standards.