Inadvertent placement of pulmonary artery catheter into right carotid artery (original) (raw)
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Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 1996
Purpose This report deals with the case of a patient who presented persistence of left superior vena cava (LSVC). This disorder was discovered following placement of a catheter in pulmonary artery via the left subclavian vein. Clinical features The patient was a 67-yr-old woman who, while in the intensive care unit after undergoing coronary revascularization with extracorporeal circulation, required pulmonary artery catheterization to guide resuscitation. Placement of the catheter proved to be difficult as the advance of the catheter was impeded. A normal pulmonary artery pressure wave was eventually detected at a distance of approximately 70 cm. Chest x-ray showed a catheter route suggestive of persistent LSVC. Conclusion A diagnosis of persistent LSVC should be considered whenever there appears to be some obstacle to central venous or pulmonary artery catheterization, especially in patients with congenital heart disease, since this disorder can have important clinical consequences. Objectif Cette observation décrit la persistance de la veine cave supérieure gauche (VCSG). L’anomalie a été découverte pendant l’installation d’un cathéter dans l’artère pulmonaire par ponction de la veine sous-clavière gauche. Caractéristiques cliniques Il s’agissait d’une patiente de 67 ans déjà admise à l’unité de soins intensifs après une chirurgie de revascularisation coronarienne sous CEC chez qui la réanimation nécessitait une cathétérisation de l’artère pulmonaire. L’installation s’est avérée laborieuse suite à l’arrêt de la progression du cathéter. Un courbe de pression artérielle pulmonaire a été décelée éventuellement après un trajet d’environ 70 cm. La radiographie pulmonaire était compatible avec la persistance de la VCSG. Conclusion Un diagnostic de persistance de VCSG doit être envisagé chaque fois qu ’on rencontre un obstacle à la progression d’un cathéter veineux central ou artériel pulmonaire, surtout chez les porteurs d’anomalies cardiaques congénitales à cause des conséquences sérieuses que cette anomalie peut entraîner.
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.
2004
A particular event concerning a Swan-Ganz catheter complication is reported. A 41-year-old woman was admitted at the emergency room of our hospital with massive gastrointestinal bleeding. A total gastrectomy was performed. During the postoperative period in the intensive care unit , the patient maintained hemodynamic instability. Invasive hemodynamic monitoring with a pulmonary artery catheter was then indicated. During the maneuvers to insert the catheter, a true knot formation was identified at the level of the superior vena cava. Several maneuvers by radiological endovascular invasive techniques allowed removal of the catheter. The authors describe the details of this procedure and provide comments regarding the various techniques that were employed in overcoming this event. A comprehensive review of evidence regarding the benefits and risks of pulmonary artery catheterization was performed. The consensus statement regarding the indications, utilization, and management of the pul...
Right ventricular perforation: a rare complication of pulmonary artery catheterization
Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, 2014
A 70 years old male underwent Coronary Artery Bypass and Graft (CABG) surgery. After induction, a Pulmonary Artery Catheter (PAC) was inserted via right IJV with some difficulty in achieving PA tracing. During distal RCA anastomosis, surgeon noticed PAC tip coming out of Right Ventricular (RV) surface. Resistance was felt on trying to pull PAC, so it was left there. Cardiac surgeon then opened the Right Atrium (RA) and pulled out the catheter. Multiple attempts during insertion of PA catheter should always raise the suspicion of PAC tip slipping back into the RV. It should be closely monitored during surgery and communicated to the surgeon.
Transcatheter retrieval and repositioning of an Amplatzer device embolized into the left atrium
Catheterization and Cardiovascular Interventions, 2000
Intracardiac stent embolization is a challenging complication in a small infant. A Palmaz stent was placed across the atrial septum in a 3-month-old boy to relieve symptoms of right-side heart failure. On routine chest radiography one week later, the stent was found to have embolized into the right ventricle. The stent was retrieved and repositioned by means of transcatheter technique, without subsequent complications. We found this method to be a viable alternative to surgery in a high-risk infant. To our knowledge, this is the first report of the successful transcatheter retrieval and repositioning of an expandable intravascular stent from an intraventricular position in an infant. (Tex Heart Inst J 2012;39 (5):639-43) S tent placement is widely used to relieve hemodynamically significant stenosis in children and adults. 1 Several transcatheter techniques have been described for atrial septal stent implantation in patients with complex congenital heart disease. 2,3 Stent embolization is one of the challenging complications. A few case reports have documented the successful transcatheter retrieval of embolized stents from the pulmonary arteries (PAs) of adults, 4-7 and one stent was similarly retrieved from the right ventricle (RV) of a 9-year-old girl. We describe the retrieval and repositioning of an embolized stent from the RV of an infant.