Morbidity and Mortality Associated With Accidentally Entrapped Pulmonary Artery Catheters During Cardiac Surgery: A Case Series

Entrapment of the Introducing Sheath of a Pulmonary Artery Catheter

“…If appropriately used, these catheters are safe and facilitate the management of patients intraand postoperatively. Complications encountered during their use have been well described, including cardiac conduction disturbances, vascular injuries, vessel thrombosis, valvular injuries, catheter knotting, entrapment and pulmonary artery haemorrhage and pulmonary infarction [3][4][5] .…”

“…Entrapment of the PAC and difficulties in the removal of entrapped PACs, leading to serious morbidity and mortality, have been reported previously 3,5 . Sites of PAC entrapment include the superior and inferior vena cavae and the left and right pulmonary arteries.…”

“…Any resistance felt during the attempt to withdraw a PAC is highly suspicious of PAC entrapment. The cause of the problem is usually knotting of the catheter related to the insertion of an excessive length of the catheter, advanced in the absence of the expected pressure changes 3,5 . knotting of the catheter is usually seen on a chest X-ray but fluoroscopy and echocardiography have been used to confirm entrapment 3 .…”

“…Entrapped PACs can be removed by surgical and non-surgical methods, judged on a case-by-case basis 3,6 . Non-surgical methods of removal require the assistance of an expert interventional radiologist and the availability of various endovascular instruments 3 . Surgical removal of the catheter involves a sternotomy, with or without the requirement for cardiopulmonary bypass 6 .…”

“…Surgical removal of the catheter involves a sternotomy, with or without the requirement for cardiopulmonary bypass 6 . Surgical removal is advocated in situations where the catheter has perforated or become firmly attached to the cardiovascular structures 3 . Problems with surgical removal relate primarily to the sternotomy, which is not only invasive but also associated with an increased risk of infection, sternal dehiscence, mediastinitis and prolonged hospitalisation 3,6 .…”