Complications Associated with Pulmonary Artery Catheters: A Comprehensive Clinical Review

Abstract

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/Central Venous Pressure Monitoring in Adults

“…[ include presence of a left bundle branch block (risk for complete heart failure), right-sided cardiac mass, tricuspid or pulmonic valve endocarditis, or presence of a mechanical tricuspid or pulmonic valve. 23 Severe tricuspid regurgitation may prevent catheter advancement. 23 3.…”

“…23 Severe tricuspid regurgitation may prevent catheter advancement. 23 3. Caution should be taken in placement and PAOP measurements in patients at increased risk for pulmonary artery rupture (eg, age >60 years, pulmonary hypertension, improper catheter position [catheter insertion >55 cm], cardiopulmonary bypass, and anticoagulation).…”

“…Caution should be taken in placement and PAOP measurements in patients at increased risk for pulmonary artery rupture (eg, age >60 years, pulmonary hypertension, improper catheter position [catheter insertion >55 cm], cardiopulmonary bypass, and anticoagulation). 23 In addition, incorrect balloon inflation (eg, overwedging or forced inflation) and failure to deflate the balloon increase the risk for pulmonary artery rupture and thrombosis. In patients at increased risk for pulmonary artery rupture, the end-diastolic pressure in the pulmonary artery should be measured rather than PAOP.…”

Competing Priorities in the Brain Injured Patient: Dealing with the Unexpected

“…63 Although the authors encourage the use of advanced hemodynamic monitoring (both invasive and non-invasive), there are many potential complications associated with both errors in hemodynamic data interpretation and iatrogenic injury related to invasive line placement. 64 Intra-hospital patient transfers (i.e., transport to operating room or imaging suite) carry its own set of complications, with serious adverse outcomes attributed to such transfers in over 30% of critically ill patients. 65 Use of any therapies or diagnostic tests that could potentially contribute to additional complications should always be considered in the context of riskbenefit ratio.…”

Perioperative temperature measurement and management: moving beyond the Surgical Care Improvement Project

“…Detecting temperature from the pulmonary artery requires an invasive catheter. Since placement of a pulmonary artery catheter is associated with several severe possible complications [22,23], insertion of the catheter is indicated for hemodynamic monitoring.…”