A Knot in the Heart

Abstract

Few diagnostic modalities in medicine have been the subject of greater debate for as long after their inception as the pulmonary artery catheter. Placement of a Swan-Ganz catheter is associated with various complications, one of which is knotting. Complications of usage of these catheters are numerous and can have devastating effects. Knotting of Swan-Ganz catheters is a rare complication that can often be managed successfully using interventional radiological techniques. The case reported is a rare case of Swan-Ganz catheter knotting resulting from inserting an excessive length of Swan-Ganz catheter into the heart. Knotting can be prevented by following the principle rule in floating Swan-Ganz catheters by correlating the inserted length of pulmonary artery catheter (PAC) with the expected change in waveform.

Intravesical catheter knotting: an unusual complication of suprapubic catheterization

“…However, the experience with our patient showed that an anticholinergic agent alone was not sufficient in preventing this complication. In fact, catheter knotting has also been reported in the heart, superior vena cava, pulmonary artery and epidural space [18][19][20][21] . Therefore, we think that catheter knotting is a more complex event and is not only due to bladder spasm.…”

Complications Associated with Pulmonary Artery Catheters: A Comprehensive Clinical Review

“…2) (41). The incidence of PACknotting is estimated to be 0.03% of all PACp lacements (41)(42)(43). Of these, PACs account fora bout two-thirds of the cases (42)(43).…”

“…The incidence of PACknotting is estimated to be 0.03% of all PACp lacements (41)(42)(43). Of these, PACs account fora bout two-thirds of the cases (42)(43). PACk notting is usually associated with inserting the catheter too far in patients prone to have coiling in the right ventricle.…”

“…Interventional endovascular techniques have been described to unknot catheters with avariety of wires, snares, and balloon catheters tailored for specific circumstances (42)(43)(44)(45). For knots that arenot amenable to endovascular techniques, large multi-loop knots, or knots with ab ow-tie configuration, open extraction via venotomy may be needed (42)(43). In one report, surgical removal was necessary in 37% of knotting cases, with 11%overall mortality due to PAC knotting (44).…”

Cardiac output monitoring: Technology and choice

“…[13] As well, many complications have been attributed to the invasiveness of the PAC leading to significant mortality and morbidity. [141516171819] Therefore, the use of PACs should be restricted to use in patients with cardiac failure and patients with pulmonary hypertension requiring titration of pulmonary vasodilator therapy. [20]…”