Pulmonary Artery Catheter Knotted in the Tricuspid Valve Apparatus Requiring Surgery With Cardiopulmonary Bypass: A Case Report (original) (raw)

Complications associated with pulmonary artery catheters: a comprehensive clinical review

Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society, 2009

Care for the critically ill patient requires maintenance of adequate tissue perfusion/oxygenation. Continuous hemodynamic monitoring is frequently utilized to achieve these objectives. Pulmonary artery catheters (PAC) allow measurement of hemodynamic variables that cannot be measured reliably or continuously by less invasive means. Inherent to every medical intervention are risks associated with that intervention. This review categorizes complications associated with the PAC into four broad groups--complications of central venous access; complications related to PAC insertion and manipulation; complications associated with short- or long-term presence of the PAC in the cardiovascular system; and errors resulting from incorrect interpretation/use of PAC-derived data. We will discuss each of these four broad categories, followed by in-depth descriptions of the most common and most serious individual complications.

Pulmonary Artery Catheter Knotting and its Successful Removal

Pulmonary artery catheter(PAC) was introduced by Swan Ganz and colleagues in 1970 for hemodynamic assessment of patients with acute myocardial infarction. PAC's provide invasive monitoring of many hemodynamic parameters which cannot be reliably estimated by clinical signs and symptoms. Use of PAC's is associated with many different complications and various studies have been done to weigh its advantages and disadvantages. Here we report one of the rarer complications of PAC knotting and its method of removal.

Bleeding from a pulmonary artery catheter temperature connection port

Journal of Cardiothoracic and Vascular Anesthesia, 1999

p ERIOPERATIVE MONITORING with a balloon-tipped flow-directed pulmonary artery catheter (PAC) has been used clinically since 1970.1 The use of a PAC for cardiac surgical patients has become common practice, with low morbidity and mortality. However, significant complications during the insertion and use of this monitor include hematoma, 2 carotid artery puncture, 2 arrhythmias, 3,4 Homer's syndrome, 5 pulmonary artery embolism or rupture, sepsis, pneumothorax, catheter knotting, or entrapment by sutures. 1,6-8 This report describes two unusual presentations of PAC entrapment by sutures not reported in the earlier literature. CASE REPORTS Case l A 76-year-old woman presented for aortic valve replacement and coronary artery bypass graft surgery (CABG). She had a history of prosthetic mitral valve replacement, chronic atrial fibrillation, recent lower gastrointestinal bleeding secondary to divertieulosis, and a permanent pacemaker for syncope. Medications included coumadin, furosemide, diltiazem, and metoprolol. Preoperative transthoracic echocardiography showed normal left ventricular size with mild hypertrophy and normal systolic function (ejection fraction, 55%). The aortic valve was severely calcified, with moderate regurgitation and peak gradients of 44 mmHg. A prosthetic (Bjrrk-Shiley) mitral valve with trivial regurgitation was also noted. Coronary angiography showed moderate atherosclerosis of the proximal left anterior descending coronary artery. The patient was premedicated with 2 mg of intramuscular lorazepam. Hemodynamic monitoring consisted of systemic and pulmonary artery catheters and a transesophageal echocardiography (TEE) probe. Anesthetic induction included intravenous midazolam, 3 mg; fentanyl, 0.75 mg; and pancuronium, 10 mg. Endotracheal intubation was uneventful. Anesthetic maintenance included midazolam, isoflurane, fentanyl, and pancuronium. The patient received 18,000 U of heparin and cardiopulmonary bypass (CPB) was initiated. A mechanical St Jude prosthetic valve was placed in the aortic position, in addition to a single saphenous vein graft to the left anterior descending artery. Separation from CPB was uneventful, and protamine, 250 nag, was administered without incident. The patient was transported to the intensive care unit with stable hemodynamics. On postoperative day 1, the patient was hemodynamically stable and weaned from mechanical ventilation. A chest radiograph showed the PAC in the right pulmonary artery with normal pulmonary artery waveforms and pressures on the monitor. However, the PAC was recording a temperature of 40°C to 41°C with corresponding oral temperatures of 37.2°C. The integrity of the PAC was checked and fresh blood was seen oozing from the hub of the temperature connection port of the PAC. While attempting to remove the PAC, resistance was encountered at the 30-cm marking of the PAC. Also, a catheter pulsation was noted that was synchronous with the cardiac cycle, A review of the chest radiograph did not show any kinking or knotting of the PAC. Steady traction on the catheter resulted in an abrupt release of the PAC. The patient remained

Unusual course of a pulmonary artery catheter

Journal of Cardiothoracic and Vascular Anesthesia, 1998

A 67-YEAR-OLD woman was admitted to the hospital with acute dyspnea. The patient's medical history was significant for type II non-insulin-dependent diabetes mellitus, hypertension, angina pectoris, congestive heart failure, chronic obstructive pulmonary disease, and cerebrovascular accident. Physical examination showed a well-developed, wellnourished white woman in moderate respiratory distregs with a respiratory rate of 40 breaths/min and use of accessory respiratory muscles. Oxygen saturation on a 100% nonrebreathing face mask was 68%. Auscultation of the heart showed a regular tachycardia (90 to 100 beats/min) and a II/VI systolic ejection murmur at the apex. The lung examination was significant for bilateral tales consistent with pulmonary edema. An electrocardiogram showed sinus rhythm, T-wave inversion in V: through Vr, and ST-segment depression in V4 through V6 consistent with a left bundle-branch block. The patient's initial management involved endotracheal intubation and diuresis. A pulmonary artery catheter was introduced through the left subclavian vein without difficulty. A chest radiograph was obtained after placement of the catheter (Fig 1). Fig 1. The patient's chest x-ray.

Evidence-based review of the use of the pulmonary artery catheter: impact data and complications

Critical care (London, England), 2006

The pulmonary artery catheter (PAC) was introduced in 1971 for the assessment of heart function at the bedside. Since then it has generated much enthusiasm and controversy regarding the benefits and potential harms caused by this invasive form of hemodynamic monitoring. This review discusses all clinical studies conducted during the past 30 years, in intensive care unit settings or post mortem, on the impact of the PAC on outcomes and complications resulting from the procedure. Although most of the historical observational studies and randomized clinical trials also looked at PAC-related complications among their end-points, we opted to review the data under two main topics: the impact of PAC on clinical outcomes and cost-effectiveness, and the major complications related to the use of the PAC.

Diagnosis and Rescue of a Kinked Pulmonary Artery Catheter

Case Reports in Anesthesiology, 2015

Invasive hemodynamic monitoring with a pulmonary catheter has been relatively routine in cardiovascular and complex surgical operations as well as in the management of critical illnesses. However, due to multiple potential complications and its invasive nature, its use has decreased over the years and less invasive methods such as transesophageal echocardiography and hemodynamic sensors have gained widespread favor. Unlike these less invasive forms of hemodynamic monitoring, pulmonary artery catheters require an advanced understanding of cardiopulmonary physiology, anatomy, and the potential for complications in order to properly place, manage, and interpret the device. We describe a case wherein significant resistance was encountered during multiple unsuccessful attempts at removing a patient's catheter secondary to kinking and twisting of the catheter tip. These attempts to remove the catheter serve to demonstrate potential rescue options for such a situation. Ultimately, successful removal of the catheter was accomplished by simultaneous catheter retraction and sheath advancement while gently pulling both objects from the cannulation site. In addition to being skilled in catheter placement, it is imperative that providers comprehend the risks and complications of this invasive monitoring tool.

The pulmonary artery catheter: In medio virtus

Critical Care Medicine, 2008

To clarify the role of the pulmonary artery catheter in the intensive care unit. Data Sources: Recent and relevant literature from MEDLINE and authors' personal databases. Study Selection: Studies on pulmonary artery catheter use and use of other monitoring devices in critically ill patients. Data Extraction: Based largely on clinical experience and assessment of the relevant published literature and in response to recent articles attacking the pulmonary artery catheter, we propose that the pulmonary artery catheter is still a valuable tool for the hemodynamic monitoring of patients with complex disease processes in whom the information obtained from the pulmonary artery catheter may influence management. We suggest that there is a need to revisit the basics of hemodynamic management and reassess the way in which the pulmonary artery catheter is used, applying three key principles: correct measurement, correct data interpretation, and correct application. Conclusion: The pulmonary artery catheter is still a valuable tool for hemodynamic monitoring when used in selected patients and by physicians adequately trained to correctly interpret and apply the data provided.