Radiographic appearance of SGC and its optimal location.
SGC (or pulmonary arterial catheter) appears as a thin, moderately radiopaque curvilinear tube that originates centrally from a subclavian or internal jugular vein and passes successively through the brachiocephalic vein, SVC, right atrium, right ventricle, and pulmonary outflow tract, with its tip optimally located in the main, right, or left pulmonary artery or within a proximal lobar pulmonary arterial branch ( Figure 22-11 ). SGCs are occasionally inserted via a femoral vein approach, entering the right atrium via the inferior vena cava (IVC). When the balloon at the catheter tip is inflated for pulmonary capillary wedge pressure measurement, a 1-cm round radiolucency at the catheter tip may be seen radiographically. A thin, short linear tubular radiopacity is also generally seen at the skin entry site, which is the vascular sheath that surrounds the SGC. The SGC can be removed while the sheath still remains in place.