Pulmonary artery catheter complications: report on a case of a knot accident and literature review

Abstract

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 pulmonary artery catheterization that were issued by a consensus conference held in 1996 are also discussed in detail.

A Rare Complication of the Pulmonary Arterial Catheterization: Migration of the Catheter in Venous Cannula Within Superior Vena Cava

“…PAK düğümlenmesi sıklıkla kateterin fazla ilerletilmesiyle oluşmaktadır. Sağ ventrikülde dilatasyon olması ve kan akımının yavaşlaması bu riski arttırmaktadır (5,9) . Basınç trasesi takibi ile kateter pulmoner artere ilerletilemediyse yeniden denemek için 30 cm işaretine kadar dikkatlice geri çekmek gerekmektedir.…”

“…hasarı, psödoanevrizma oluşumu gibi yaşamı tehdit edici komplikasyonlar görülebilir (1)(2)(3)(4)(5) .…”

Nonsurgical Removal of Knotted Pulmonary Artery Catheter

“…Knotting of PAC is thought to occur when passage into the pulmonary artery is unsuccessful and looping occurs within the right ventricle [7]. This looping over of the PAC may be due to insertion of an excessive length of the PAC [7].…”

“…This looping over of the PAC may be due to insertion of an excessive length of the PAC [7]. Inability to obtain a wedge pressure should prompt retraction to 30 cm and reattempt flotation into the pulmonary artery [7].…”

“…evaluation can also assist with diagnosis and PAC knot location as noted in our cases. Several strategies for both surgical and nonsurgical knotted PAC removal have been described [6][7][8][9]. Insertion of a core-guided wire through the PAC under fluoroscopy is often a first step in attempt to unravel the knotted catheter [6][7][8][9][10].…”