Management of an Unusual Complication During Placement of a Pulmonary Artery Catheter (original) (raw)
Related papers
Journal of Clinical Anesthesia, 2009
A complication following placement of the pulmonary artery catheter (PAC) is presented. Resistance was experienced during insertion of the introducer sheath, and the PAC could not be advanced into the right heart. Finally, the PAC was successfully placed through the left internal jugular vein. Perforation of the right innominate vein was identified following emergent exploratory surgery for cardiovascular collapse.
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.
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.
BMJ case reports, 2014
A 54-year-old man was admitted to the intensive care unit following cardiac surgery. On day 6 postoperatively, approximately 2-3 min following the removal of the pulmonary artery (PA) catheter introducer sited in the right internal jugular vein, the patient became agitated, confused and then unresponsive. He was urgently moved onto the bed, laid supine, sedated with a propofol infusion, intubated and mechanically ventilated. A bedside transthoracic echocardiogram revealed extensive multiple air emboli in all cardiac chambers and review of the patient's intraoperative imaging confirmed the presence of patent foramen ovale (PFO). The following morning, sedation was discontinued and the trachea extubated. The patient was later transferred to the ward and then discharged home with no evidence of neurological deficit. This case reminds us of the importance of strict adherence to safety protocols when manipulating centrally positioned catheters and the high prevalence of undiagnosed PFO.
Inadvertent Puncture of the Thoracic Duct During Attempted Central Venous Catheter Placement
CardioVascular and Interventional Radiology, 2003
We report a case of puncture of the thoracic duct during left subclavian vein catheterization on the intensive care unit. Computed tomography and measurement of the triglyceride levels in the aspirated fluid proved the inadvertent penetration of the guidewire into the thoracic duct. Early recognition of central line misplacement avoided serious complications. Inadvertent central venous catheter placement into the thoracic duct may have the potential complications of infusion mediastinum and chylothorax.
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.
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...