Catheterization of the Right Auricle in Man

Forssmann first used catheterization of the right heart on himself, after exposure of a vein of the arm by a surgeon. Numerous other investigators since have used right heart catheterization for visualization of the right chamber of the heart and pulmonary vascular trees by means of contrast substance. The introduction of the Robb and Steinberg method, however, renders this method unnecessary for the latter purpose. Collection of right heart blood by catheterization of the right auricle for determining cardiac output in man is mentioned by Grollman, who discredits it because of the possible dangers and numerous misleading factors associated with it. In animal experimentation it is widely used and its innocuity established.Because it is apparently the soundest method for obtaining mixed venous blood for respiratory gas determinations, and because of the numerous problems of hemodynamics it might help solve, a method of right heart catheterization was developed which attempts to overcome objections to former methods. The principal objections included the possibility of venous thrombi and thrombophlebitis that might be associated with introduction of a foreign body in the blood stream, the formation of thrombi within the catheter, and the psychic effects accompanying the procedure with possible alterations in the cardiac output.The following equipment was used in our method: a specially made 10 gauge Lindeman type of needle; a 3-way stopcock with a Luer lock, tightly fitting adapter; a No. 8 French flexible radiopaque ureteral catheter with 2 holes, one at the rounded tip and another about 1 cm from the tip. The catheter is silk with a smooth varnish finish. A saline reservoir with rubber tubing and clamp for controlling the rate of flow was also used.Under the strictest asepsis a nick is made in the skin over the median basilic vein of either the right or left arm after a preliminary infiltration with 2% novocain.