Entrapment of pulmonary artery catheter in a suture at the inferior vena cava cannulation site

Huang, Liguang; Elsharydah, Ahmad; Nawabi, Atta; Cork, Randall C.

doi:10.1016/j.jclinane.2004.02.003

Cited by 32 publications

(18 citation statements)

References 10 publications

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“…The continuous thermodilution technique using a catheter placed in the pulmonary artery is widely used to assess CO in critically ill patients [19,20]. Although this method is believed to be quite accurate under most clinical conditions [21,22], the process of acquiring central venous access and a balloon floating through the right heart can cause complications, which are sometimes fatal [23,24]. The Vigileo/FloTrac is a valuable tool for the management of patients with diseases such as cardiovascular dysfunction and critical illness or in those undergoing major surgery [25,26] or who are exposed to situations of changing arterial pulse contour [27-29].…”

Section: Resultsmentioning

confidence: 99%

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Kim

Choi

et al. 2012

World J Surg Onc

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BackgroundCurrently, data are not available concerning a safe insufflation pressure that provides a proper view of the surgical field without adverse metabolic and hemodynamic changes in humans undergoing the robot-assisted thyroidectomy bilateral axillo-breast approach (BABA) using the da Vinci robotic surgical system. The purpose of this study was to determine the optimal carbon dioxide (CO2) insufflation pressure in patients with various benign and malignant thyroid diseases when using the da Vinci robotic surgical system.MethodsA total of 32 patients underwent thyroid surgery at 6 (n = 15), 9 (n = 15), and 12 (n = 2) mmHg. The partial pressure of carbon dioxide (PaCO2), pH, cardiac output, heart rate, and mean arterial pressure were measured at baseline, 30 min and 1, 1.5, and 2 hours after CO2 insufflation, and 30 min after desufflation.ResultsCO2 insufflation of 12 mmHg caused severe facial subcutaneous emphysema, hypercarbia, and acidosis during robot-assisted thyroidectomy with BABA. The study was stopped before completion for the patients’ safety in accordance with the study protocol. Applying 6- or 9- mmHg of CO2 insufflation pressure caused increases in PaCO2 and decreases in arterial pH. However, vital signs were stable and pH and PaCO2 were within the physiologic range during the surgery in the 6- and 9-mmHg groups.ConclusionsWe propose that a CO2 insufflation pressure under 10 mmHg in robot-assisted thyroidectomy with BABA is the optimal insufflation pressure for patient safety.

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Section: Resultsmentioning

confidence: 99%

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Kim

Choi

et al. 2012

World J Surg Onc

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“…During open heart surgery, the CVC tends to lie against the lateral or the posterior wall of the right atrium, where it may be caught by a suture in the during venous cannulation for CPB [8]; however, suturing of a CVC or pulmonary artery catheters (PACs) to heart and vessels by cardiac sutures has rarely been reported [2, 8]. Although the literature contains few reports of other types of CVC entrapments, we believe that our case to be one of the very few reports of CVC was sutured surgically to the wall of the right atrium while doing the purse suture for inserting the inferior vena cava cannula prior to CPB and necessitated reexploration of the chest to remove it.…”

Section: Discussionmentioning

confidence: 99%

“…Huang et al [8] similarly reported entrapment of a Swan-Ganz catheter in the purse-string suture in a patient undergoing aortic valve replacement. Our case was also during valve replacement CABG surgery.…”

Section: Discussionmentioning

confidence: 99%

Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

Anvaripour

Yazdanian

Totonchi

et al. 2011

Case Reports in Anesthesiology

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A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

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“…Pulmonary artery catheter entrapment has been reported at the inferior vena cava cannulation site [1] and infrarenal inferior vena cava filter placed for deep vein thrombosis [2]. Entrapment on the tricuspid valve was reported by Schregel et al [3].…”

Section: Discussionmentioning

confidence: 99%

Transoesophageal echocardiography: a useful tool to diagnose entrapment of pulmonary artery catheter

2006

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SummaryPlacement of a pulmonary artery catheter during cardiac surgery is associated with various complications, one of which is entrapment. On the day following surgery unusual resistance was encountered while attempting to remove a pulmonary artery catheter from a patient who had undergone coronary artery bypass grafting. Entrapment of the catheter was confirmed by transoesophageal echocardiography, which demonstrated invagination of the free wall of the pulmonary trunk on gentle traction on the pulmonary artery catheter. Surgical exploration revealed that the catheter was transfixed by the suture used to close the pulmonary artery vent site. Surgical re-exploration and other potential complications related to catheter retrieval can be avoided if catheter entrapment is diagnosed intra-operatively. We suggest that a high index of clinical suspicion along with the use of intra-operative transoesophageal echocardiography is considered in situations where catheter entrapment is a possibility. The pulmonary artery catheter is commonly used for haemodynamic monitoring of cardiac surgery patients with compromised ventricular function. We report a case of accidental entrapment of a pulmonary artery catheter at the pulmonary artery vent suture site in a patient undergoing coronary artery bypass surgery. Transoesophageal echocardiography was helpful in correctly and promptly diagnosing the underlying problem. Case reportA 52-year-old male with history of diabetes, triple vessel disease and severe left ventricular dysfunction underwent elective coronary artery bypass surgery. A size 7F pulmonary artery catheter (Edward Life Sciences, Irvine, CA) was inserted without difficulty through a percutaneous sheath introducer (8.5F, Edward Life Sciences) inserted into the right internal jugular vein and a normal pulmonary artery tracing was obtained at 45 cm. A 14F pulmonary artery vent (Romson's plain plastic catheter) was inserted to decompress the heart while the patient was on cardiopulmonary bypass. After uneventful separation from bypass, the pulmonary artery vent was removed and the vent site was closed with 5-0 purse string prolene sutures. Postoperative care was provided in the intensive care unit. The patient was extubated 6 h after surgery. Inotropes were gradually tapered off over the next 24 h and removal of the pulmonary artery catheter was planned prior to transfer to the high dependency unit.On attempting to remove the pulmonary artery catheter unusual resistance was encountered. A chest X-ray revealed that the pulmonary artery catheter was located in the left pulmonary artery with a sharp bend at the highest point in the pulmonary trunk. Transoesophageal echocardiography (Agilent Technologies, Andover, MA) was performed under conscious sedation to determine the cause of the resistance. A mid-oesophageal right ventricular outflow tract view was obtained which showed the pulmonary artery catheter passing through the right ventricle, right ventricle outflow tract and pulmonary trunk. Gentle traction on the pulmonary...

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Entrapment of pulmonary artery catheter in a suture at the inferior vena cava cannulation site

Cited by 32 publications

References 10 publications

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Optimal carbon dioxide insufflation pressure during robot-assisted thyroidectomy in patients with various benign and malignant thyroid diseases

Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

Transoesophageal echocardiography: a useful tool to diagnose entrapment of pulmonary artery catheter

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