To the Editor.—The Swan-Ganz catheter has become an important tool for monitoring critically ill surgical patients in the intensive care unit.1 Like all invasive diagnostic or therapeutic modalities, the Swan-Ganz catheter is associated with infrequent, but real, risks. Cardiac arrhythmias, perforation of the pulmonary artery, pulmonary infarction, and catheterassociated bacteremia are among such complications. The passage of the catheter in critically ill patients, even those with intrinsic cardiac disease, is reputed to be safe, although transient rhythm disturbances may be identified in as many as 30% of the patients at the time of placement.2
Reports of fatal or near-fatal cardiac arrhythmias are rare. Thus, there are essentially no contraindications to Swan-Ganz catheter placement. Our recent experience suggests that a patient with hyperkalemia and metabolic acidosis may not warrant immediate catheter placement.
Report of a Case.—A 73-year-old man underwent a coronary artery bypass for symptomatic ischemic heart