Potential sources of error when performing right heart catheterisation and guidance on how to minimise the impact of these errors

Potential error classPotential errorRiskSolution
MeasurementCatheter balloon over-inflationFalse high or low PAWP readings [41]Half inflation of the balloon (diameter ∼0.9 cm, 0.75 mL air) [42]
Pulmonary arterial rupture [41]Avoid repeated inflations and deflations of the balloon [29]
Catheter balloon under-inflationFalse elevation of PAWP readings [41]Half inflation of the balloon (diameter ∼0.9 cm, 0.75 mL air) [42]
Use of end-expiratory PAWP readingsMisdiagnosis of patients with a pre-capillary phenotype [43, 44]Average PAWP readings across respiratory cycles [44]
Analysing single cyclePotential data inaccuracy [44]Mean values of multiple respiratory cycles should be used [44]
Variation in the location of the pressure transducerNonuniformity of the pressure transducer setting and zero levelling [29, 45]Standardised location of pressure transducer according to guideline recommendations [1, 2, 40, 44] or adoption of micromanometer-tipped catheters [44]
Data interpretationFailure to review tracesData inaccuracy (measurement artefacts) [41]Each trace should be scrutinised to ensure that it is not affected by artefacts [41]
TechnicalIncorrectly maintained or calibrated equipmentErrors in data acquisition [41]Equipment maintained to a high standard and regular calibration [41]
Inadequate flushing of the catheterDampened waveforms [41]Adequate flushing [41]
  • PAWP: pulmonary arterial wedge pressure.