Table 1.

Best practice technique for right heart catheterization.

	Best Practice Technique
General considerations
Preparation	Review patient characteristics and imaging to understand pretest probability of various diagnoses. Confirm hemodynamic findings fit the clinical scenario. Operators should have an unobstructed view of hemodynamic monitors and real-time ECG
Patient positioning	Supine position with legs flat; avoid recording while patient is talking, coughing, or under duress
Sedation	Minimize systemic sedation when possible to avoid altered breathing patterns
Leveling	Pressure transducer should be zeroed to atmospheric pressure at level of left atrium (halfway between the anterior sternum and table surface)
Tracing quality	Watch for signs of over- or under-dampening (see Figure 3). If under-dampening is present, catheter ringing can be reduced by introducing a small amount of blood or contrast into the fluid filled catheter
Respiratory Cycle Considerations	Pressure measurements should be recorded during spontaneous breathing without breath hold maneuvers (due to concern for inadvertent Valsalva and preload alteration) If Cheyne-Stokes breathing is present, operators should measure each pressure value during the same phase of the breath cycle End-expiratory measures are preferred for most situations
PAWP Measurement
Confirmation of complete PA occlusion	Measure PAWP SaO2
“Normal” PAWP but risk factors for PH-LHD	Consider provocative maneuvers (i.e. saline bolus)
Presence of large V waves	Suggestive of LHD and/or mitral regurgitation and should be reported
Cardiac Output Measurement
	In absence of intracardiac shunting, thermodilution is preferred over indirect Fick for estimation of cardiac output and associated hemodynamic calculation.

ECG, electrocardiogram; PAWP, pulmonary artery wedge pressure; SaO₂, mixed venous oxyhemoglobin saturation; LHD, left heart disease; PH, pulmonary hypertension.