Background Right heart catheterization (RHC) is a critical part of the diagnosis and subsequent treatment of advanced heart failure and cardiogenic shock. With increasing literature supporting mechanical ventricular assist devices, hemodynamic assessment in the acute setting is paramount to improving outcomes. This study is meant to evaluate the safety of ultrasound guided Swan-Ganz catheter (USSGC) insertion when compared to RHC done in the catheterization laboratory, with respect to major adverse events. Hypothesis USSGC insertion has a similar risk of serious adverse event when compared to RHC done in the catheterization laboratory with fluoroscopy. Methods Retrospective chart analysis was performed on patients admitted to Deborah Heart and Lung Center and undergoing RHC in a one-year period from 1/1/2019 until 12/31/2019. Clinical course was monitored following the procedure for major adverse events within 48 hours. Major adverse events related to the procedure were defined as pneumothorax requiring chest tube intervention, BARC bleeding class 3-5, pulmonary artery rupture, pulmonary infarction or venous fistula. These data were then compared between the two groups. The number of delayed days from the procedure recommendation until completion between the two groups was compared using negative binomial regression. Results Of 339 patients who underwent the procedure, 216 were performed at the bedside with USSGC, and 123 performed in the catheterization lab with fluoroscopy. There were no major adverse events in either groups. Delay to procedure was significantly lower in the USSGC group (0.02 days) compared to fluoroscopic group (1.4 days) which is a reduction of 33.6 hours in the USSGC group (P Conclusions Ultrasound guided Swan-Ganz right heart catheterization at the bedside appears to be equally as safe as fluoroscopic RHC done in the catheterization laboratory, as our analysis showed no major adverse events in both groups. Additionally, we found that USSGC insertion at the bedside was performed on average 1.4 days or 33.6 hours sooner than RHC in the catheterization lab. Further prospective studies are needed to see if rapid insertion of USSGC will lead to improved clinical outcomes in the setting of cardiogenic shock and advanced heart failure.