Pitfalls of Swan-Ganz catheterization

Shin, Byung Seop; Ayella, Robert J.; McAslan, T. Crawford

doi:10.1097/00003246-197705000-00001

Cited by 46 publications

(9 citation statements)

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“…Rupture of the pulmonary artery in their patient occurred when the balloon was inflated with 0.75 nil of saline. Since then, many reports (5)(6)(7)10,12,15,17) mention the relationship between balloon inflation and pulmonary artery rupture. The present study shows that the distal pulmonary arteries of subjects under the age of 60 are remarkably resistant to rupture and tolerate intraluminal pressures of approximately 4000 mm Hg before rupturing.…”

Section: Discussionmentioning

confidence: 99%

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Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Hardy

Morissette

Taillefer

et al. 1983

Anesthesia & Analgesia

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of rupture of the pulmonary artery by pulmonary artery balloon-tipped catheters. Anesth Analg 1983;62:925-30. High pressures have been reported in pulmonary artery catheter balloons. This study was undertaken to determine the in vitro rupturing pressures of human peripheral pulmonary arteries and to evaluate whether such pressures could be generated under clinical conditions. The in vitro model then was confirmed in vivo in the dog and the evolution of a rupture of a peripheral pulmonary artery studied. In vitro, pulmonary arteries of subjects under age 60 yr are remarkably resistant and tolerate intra-balloon pressures of 2700 mm Hg in the one mid-pulmonary artery studied and up to 4219 k 720 mm Hg (mean 5 SD) in the distal pulmonary artery. Subjects over the age of 60 yr have significantly lower rupturing pressures (1965 * 540 mm Hg in the mid-pulmonary artery, and 2498 2 600 mrn Hg in the distal pulmonary artery), (P < 0.05). Thus overdistension by the balloon may explain most ruptures. Preexisting pulmonary hypertension did not affect in vitro rupturing pressures. Clinicians generated intraballoon mean pressures of 795 ? 130 mm Hg, with 20% of them generating higher and potentially dangerous pressures (1000 mm Hgor more). The in vitro model was confirmed by in vivo studies in dogs with pressures that cause pulmonary artery rupture. Furthermore, in normal dogs, rupture of a peripheral pulmonary artery was without complications. This suggests that rupture of the peripheral pulmonary artery may occur clinically more frequently than reported. The user of flotation pulmonary arterial catheters should be aware of the dangers associated with this diagnostic tool. In particular, liquids must never be used to inflate pulmonary arterial catheter balloons.

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Section: Discussionmentioning

confidence: 99%

“…Rupture of the pulmonary artery is generally viewed as the most serious complication associated with use of balloon-tipped pulmonary arterial catheters. To our knowledge, 29 cases have been reported in the literature between 1971 and 1982 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). Forty-five percent of these were fatal.…”

mentioning

confidence: 99%

Pathophysiology of Rupture of the Pulmonary Artery by Pulmonary Artery Balloon-Tipped Catheters

Hardy

Morissette

Taillefer

et al. 1983

Anesthesia & Analgesia

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“…Mechanisms of importance in catheter‐induced rupture are: perforation of the vessel with the catheter tip by a peripherally advanced catheter or by eccentric balloon inflation, damage of the vessel by withdrawal of a firmly wedged catheter or overdistention of the vessel [2, 4, 8, 9]. If pulmonary artery rupture is diagnosed both surgical and nonsurgical procedures, such as bronchoscopy with tamponade of the bleeding site using a Fogarty catheter, double lumen endotracheal intubation and 20 cmH 2 O positive end‐expiratory pressure (PEEP) ventilation are tested forms of treatment, with comparable results.…”

Section: Discussionmentioning

confidence: 99%

Opacity over the left hemithorax after abdominal aortic aneurysm repair

2000

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A 77-yr-old male was admitted for aortic aneurysm repair. His history recorded hypertension, left carotid artery desobstruction, stroke and an anterior invocardial infarction. Aspirin was discontinued 1 day before surgery. For peri-and postoperative haemodynamic surveillance, a Swan-Ganz catheter (7.5 Fr thermodilution catheter; Criticath; Ohmeda, Bilthoven, the Netherlands) was introduced through the venae cubiti of the right arm 1 day before surgery. Initially the catheter was in overwedged position. After withdrawal of the catheter a correct wedge curve was obtained. As a result of congestive heart failure, there were elevated pulmonary artery and wedge pressures. For this reason, the patient was treated with diuretics and nitroglycerin intravenously.The abdominal aortic repair was uncomplicated, with a blood loss of 1,900 mL. After surgery the chest radiograph showed a diffuse opacity over the left hemithorax ( fig. 1).

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“…La plupart des cas rapportés dans la littérature l'ont été lors de la manipulation du ballon ou lors de manoeuvres d'inflation ou de déflation [11,12]. Les principaux mécanismes évo-qués sont la surinflation, l'inflation excentrique et l'impaction intramurale de l'extrémité du cathéter [13,14]. Le site de perforation est extrêmement difficile à localiser en cas de rupture distale même après analyse des pièces d'autopsies [15,16].…”

Section: Introductionunclassified