What action should be taken with ECMO during Swan-Ganz catheter insertion?

Turning down the flows during Swan-Ganz catheter insertion is a commonly recommended action while managing ECMO support. This maneuver is critical for several reasons.

First, reducing the flow rates can help mitigate the risk of complications during the catheter placement procedure. By lowering flows, you can minimize the shear stress and turbulence within the circulation. This is particularly important when manipulating the catheter, as high flow conditions can lead to complications such as hemodynamic instability or transfusion reactions if air or debris is introduced inadvertently.

Additionally, reduced flow allows for better visualization and easier manipulation of the catheter within the cardiovascular system, which can be essential for accurate placement and to avoid damaging surrounding structures, particularly in a delicate setting.

Therefore, turning down the flows is a prudent and standard practice during the insertion of a Swan-Ganz catheter while on ECMO support, ensuring both patient safety and the success of the catheter placement.