Dilated aortic root influences pulmonary artery catheter placement in anesthetized patients

Miyata, Yuka; Wada, Tsutomu; Hayasaka, Tomohiko; Hayashi, Yukio

doi:10.1186/s40981-018-0152-7

Cited by 3 publications

(1 citation statement)

References 11 publications

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“…In this study, we examined the effect of experience on the quality of PAC placement and we evaluated the quality with two parameters, that is, the time required for PAC placement and incidence of ventricular arrhythmias during PAC placement. According to our previous studies,[ 5 6 ] the time required for PAC placement was defined as the duration of time required for the catheter to float from the CVP position through the right heart chambers to the pulmonary artery, and we also continuously recorded electrocardiogram tracings during the placement in our monitoring system to review arrhythmias after the catheter placement and we classified arrhythmias as absent or multiple (three or more consecutive) ventricular arrhythmias.…”

Section: Methodsmentioning

confidence: 99%

An analysis of prior experience influencing quality of pulmonary artery catheter placement in residents

et al. 2020

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Background: Prior experience may be important for successful placement of a pulmonary artery catheter (PAC). However, there is no report about the minimum number of the placement to reach acceptable technique for the catheter placement during residency. Aims: This study was designed to examine quality of the catheter placement and to assess the effect of prior experience. Setting and Design: Prospective, observational, cohort study. Methods: This study included eight residents and one experienced staff in our hospital. We prospectively examined the performance of placement of a PAC in eight residents for the first 2 months of their training period and one staff for previous 2 years. We examined the time required for the catheter placement and probability of ventricular arrhythmias during the placement. Each resident and the staff reported approximate number of past experience of the catheter placement according to the self-statement. In addition, we continued to examine the placement of a PAC in one resident with zero experience to show his improvement. Statistical Analysis: Statistical analysis was performed by Kruskal–Wallis test, Mann–Whitney test, or Fisher's exact test as appropriate and Benjamini and Hochberg method was used for multiple comparisons. Results: The catheter placement time and probability of the ventricular arrhythmias of two residents with zero experience of the placement were significantly larger than those of the staff. On the other hand, the placement quality of the other residents who experienced at least 20 PAC placements was not significantly different from that of the staff. The placement quality of one resident with zero experience became comparable with that of the staff after 20 placements. Conclusion: Our data suggested that about 20 catheter placements may be required to reach acceptable technical level for the PAC placement.

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Section: Methodsmentioning

confidence: 99%

An analysis of prior experience influencing quality of pulmonary artery catheter placement in residents

et al. 2020

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An analysis of factors influencing pulmonary artery catheter passage through the tricuspid and pulmonary valves

et al. 2020

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Purpose A pulmonary artery catheter (PAC) has to pass the tricuspid and pulmonary valves for its proper placement. Although several factors were reported to hinder the placement, there have been no reports to identify the factors that prolong the individual time for passing through each valve. Method We individually measured the time required for a PAC to pass through the tricuspid and pulmonary valves. We examined the effect of the following factors on those times: the patient’s age, sex, height, weight, cardiothoracic ratio, tricuspid regurgitation, left ventricular ejection fraction, and the diameters of the sinus of Valsalva and of the sinotubular junction divided by the body surface area which represent the diameter of the aorta. Data were analyzed by multiple linear regression analysis after univariate analysis. Results The placement of a PAC was successful in all of 100 patients. The time required to pass through the pulmonary valve was significantly longer than that through the tricuspid valve (15 [10–28] s vs 9 [5–16] s, median [range], P < 0.01). The incidence of ventricular arrhythmias during passage through the pulmonary valve was significantly higher than that through the tricuspid valve (17% vs 0%, P < 0.01). Tricuspid regurgitation and the diameter of sinotubular junction had a significant positive association with the time required to advance a PAC through the pulmonary valve, although there was no significant factors that increased the time required to advance a PAC through the tricuspid valve. Conclusion The time required to advance a PAC through the pulmonary valve is much longer than that to pass through the tricuspid valve. The diameter of aortic root and tricuspid regurgitation are significant factors that increased the time required to advance a PAC through the pulmonary valve.

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Bedside Clinician’s Guide to Pulmonary Artery Catheters

Fox,

Marshall,

Walters

et al. 2023

Critical Care Nurse

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Background Pulmonary artery catheters provide important information about cardiac function, mixed venous oxygenation, and right-sided pressures and potentially provide temporary pacing ability. Objective To provide bedside clinicians with guidance for techniques to insert right heart monitors and devices, describe risk factors for difficult insertion and contraindications to placement, and provide updates on new technologies that may be encountered in the intensive care unit. Methods An extensive literature review was performed. Experienced clinicians were asked to identify topics not addressed in the literature. Results Advanced imaging techniques such as transesophageal echocardiography or fluoroscopy can supplement traditional pressure waveform–guided insertion when needed, and several other techniques can be used to facilitate passage into the pulmonary artery. Caution is warranted when attempting insertion in patients with right-sided masses or preexisting conduction abnormalities. New technologies include a pacing catheter that anchors to the right ventricle and a remote monitoring device that is implanted in the pulmonary artery. Discussion Bedside clinicians should be aware of risk factors such as atrial fibrillation with dilated atria, decreased ventricular function, pulmonary hypertension, and right-sided structural abnormalities that can make pulmonary artery catheter insertion challenging. Clinicians should be familiar with advanced techniques and imaging options to facilitate placement. Conclusion The overall risk of serious complications with right heart catheter placement and manipulation is low and often outweighed by its benefits, specifically pressure monitoring and pacing.

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Dilated aortic root influences pulmonary artery catheter placement in anesthetized patients

Cited by 3 publications

References 11 publications

An analysis of prior experience influencing quality of pulmonary artery catheter placement in residents

An analysis of prior experience influencing quality of pulmonary artery catheter placement in residents

An analysis of factors influencing pulmonary artery catheter passage through the tricuspid and pulmonary valves

Bedside Clinician’s Guide to Pulmonary Artery Catheters

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