Complications of the Flow-Directed Pulmonary Artery Catheter

We report the case of a 64-year-old patient in whom a pulmonary artery catheter formed a knot fixed within the right ventricle in the region of the tricuspid valve apparatus. Knot formation is a recognized complication associated with pulmonary artery catheters (PAC) insertion. This problem is usually dealt with by simply withdrawing the PAC until the knot impacts onto the introducer and after enlarging the puncture site by a small skin incision removing the introducer-PAC as one unit. However, we recently encountered a situation where the PAC was knotted around the tricuspid valve apparatus and could not be withdrawn. An interventional radiologist was able to unknot the catheter and release it from the tricuspid valve. We reviewed the literature related to this topic. We believe our experience could be of use to others.

show abstract

“…[234567] The use of ultrasound for insertion of the sheath has been shown to reduce all these complications. [8]…”

Section: Discussionmentioning

confidence: 99%

Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

2013

View full text Add to dashboard Cite

show abstract

“…However, this knowledge is not gained without the price of major complications and significant infection rates in patients so monitored. 8 On the other hand, the QF interval readily lends itself in an atraumatic fashion to following patients with congestive heart failure, thyrotoxicosis, cardiac pacemakers, hypoxia, myocardial infarction, valvular disease, hypertension, and many other diseases or conditions. The child used as an example in this article was monitored with an indwelling radial artery cannula, but in most cases of measurement with the QF interval, a simple pressure pulse transducer has been used for obtaining the wave form.…”

Section: Case Historymentioning

confidence: 99%

The Simple Measurement of Heart Function During Intensive Care and Surgery

Reitan¹

2008

Seminars in Respiratory Medicine

View full text Add to dashboard Cite

Two methods of cardiac evaluation are presented. The first, the endocardial viability ratio, measures the relationship between oxygen supply and demand in the heart. The second, a systolic time interval, monitors left ventricular performance. Both indices are applicable to most dynamic and static circulatory conditions and are suitable for beat-to-beat evaluation in patient care. ENDOCARDIAL VIABILITY RATIO CASE HISTORYA 26-year-old woman gave vaginal birth to her first child in a small Australian provincial hospital and developed complications during the delivery, including a pulmonary amniotic embolus. She was transferred by air to the Royal Newcastle Hospital and admitted to the intensive care unit. The patient was hypotensive and in respiratory distress. Laboratory studies showed hypoxemia, anemia, coagulopathy, and bilateral infiltrates on chest x-ray. She was treated by mechanical ventilation with PEEP, fluid administration, intravenous coagulation factors, and blood. Because of the delay in therapy she developed significant arterial hypotension, presumably from endogenous vasoactive substances released after the amniotic fluid embolus. Her diastolic pressure was most affected, while systolic pressure seldom fell below 80 torr (a sign of a basically strong heart). In order to monitor her cardiac function a modified V5 ECG lead was placed, and a small special purpose computer was attached to the output from the radial artery pressure transducer to measure the endocardial viability ratio (EVR). Whenever her heart rate accelerated above 100 beats/min and the diastolic pressure fell below 40 torr, cardiac ischemia recurred as manifested by ST segment changes in V5. Yet prior to the ECG evidence of myocardial hypoxia, the EVR fell below 0.4, a level well under the suspected "break point" for subendocardial ischemia. 1 By judicious use of dobutamine and phenylephrine her blood pressure and left-sided heart work were regulated to avoid cardiac ischemia so that the EVR remained above 0.4. There was no further ECG evidence of cardiac ischemia. Unfortunately, she suffered from an unremitting coagulopathy and died after a major cerebral hemorrhage associated with severe hypoxemia.The endocardial viability ratio (EVR) was described by Buckberg and colleagues in 1972 and is based on two precepts. 2 First, the work of Sarnoff and associates was used to show that the left ventricular (LV) stroke oxygen consumption is proportional to the area under the LV pressure curve. 3 This area, called the time tension index (TTI), may be calculated from a peripheral pulse instead of the LV curve by ignoring the isovolemic contraction and relaxation areas (Fig. 1). Correlations between left-sided heart oxygen consumption and the area under the systolic portion of the pulse wave are close and reproducible over wide ranges of left-sided heart work. 4 Second, the gradient between aortic diastolic and left ventricular diastolic pressures is thought to describe the perfusion head for subendocardial coronary blood flow. 1 Because perivascu...

show abstract

“…Sise et al . [14] found an increase in infection and an increase in the incidence of catheter fault with approximately 20% of catheters after 6–7 days. However, complications are few in skilled, experienced hands and can be readily anticipated.…”

Section: Possibilities For Systemic Hemodynamic Monitoringmentioning

confidence: 99%

Untitled

Boldt

2002

Crit Care

View full text Add to dashboard Cite

Since the beginning of modern anesthesia, in 1846, the anesthetist has relied on his natural senses to monitor the patient, aided more recently by simple technical devices such as the stethoscope. There has been a tremendous increase in the availability of monitoring devices in the past 30 years. Modern technology has provided a large number of sophisticated monitors and therapeutic instruments, particularly in the past decade. Most of these techniques have enhanced our understanding of the mechanism of the patients' decompensation and have helped to guide appropriate therapeutic interventions. As surgery and critical care medicine have developed rapidly, patient monitoring capability has become increasingly complex. The most important aspect in monitoring the critically ill patient is the detection of life-threatening derangements of vital functions. Aggressive marketing strategies have been promoted to monitor almost every aspect of the patient's status. However, these strategies are only telling us what is possible; they do not tell us whether they enhance patient safety, improve our therapy, or even improve patient outcome.

show abstract

Complications of the Flow-Directed Pulmonary Artery Catheter

Cited by 14 publications

References 0 publications

Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus

The Simple Measurement of Heart Function During Intensive Care and Surgery

Untitled

Contact Info

Product

Resources

About