ABSTRACT
A recent fatal accident related to the use of the pulmonary artery catheter (PAC) promoted us to conduct a questionnaire survey to assess the current use of the PAC and its complications during cardiac surgery. Methods : A 10-item questionnaire was distributed to all board-certified cardiovascular surgery centers in Japan. Five hundred thirty-two questionnaires were distributed and 325 (61.1%) were returned. Results : Seventy-two percents of hospitals used the PAC in more than 90% of cases, while only 17% used it less than 50% of the time. Indication of its use was not clearly determined in 52% of hospitals. Entrapment of the PAC was experienced in 28% of centers in the last 10 years, and its incidence was calculated as 0.07%. At a quarter of hospitals, checking for PAC to confirm absence of entrapment was not performed during the operation. Pulmonary artery rupture occurred at 22% of hospitals, and its incidence was 0.05%. Agreements on handling PAC to prevent cardiac injury or pulmonary artery rupture were not made in 24 and 56% of hospitals respectively. Conclusion : These data demonstrate that in many of the cardiac surgery centers in Japan, the PAC is still routinely used. Serious complications including catheter entrapment and pulmonary artery injury were encountered in a substantial number of patients. Development of guidelines for PAC during cardiac surgery to limit its use to patients with clear benefits and prevent related complications is warranted.
ABSTRACT
Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Subject(s)
Humans , Arteries , Catheters , Exsanguination , Hemodynamics , Hemoptysis , Hemothorax , Mortality , Pulmonary Artery , RuptureABSTRACT
Pulmonary artery rupture with a flow-directed balloon tipped pulmonary artery catheter (Swan-Ganz catheter)is a rare complication with high mortality. This report concerns a case of this complication with hemothorax leading to fatal exsanguination. Emphasis is placed on the safety guidelines to prevent this. Also, possible causes and managements are presented. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained hemodynamic or respiratory changes.
Subject(s)
Humans , Arteries , Catheters , Exsanguination , Hemodynamics , Hemoptysis , Hemothorax , Mortality , Pulmonary Artery , RuptureABSTRACT
Proper positioning of pulmonary artery catheter and predicting distal migration of it during cardiopulmonary bypass is important for the prevention of perioperative complication of pulmonary artery rupture. The authors therefore examined the insertion length of pulmonary artery catheter via right internal jugular vein at which catheter tip was advanced to the most proximal position where pulmonary capillary wedge pressure could be obtained. And also the distal migration is measured by comparing the difference between prebypass and postbypass corrected length. Just before bypass, pulmonary artery catheter was arbitrarily receded 5cm for the prevention of spontaneous distal migration and wedging. The subjects were 47 patients who underwent open heart surgery (valve replacement, coronary artery bypass graft) during the period of November, 1992 through April, 1993. The results were as follows. 1) The insertion length of pulmonary artery catheter from skin to the right ventricle inlet, pulmonary artery inlet and pulmonary capillary wedge position were 26.5+/-3.0 cm, 36.8+/-4.9 cm and 46.1+/-5.7 cm respectively. 2) There were no significant statistical correlations between insertion lengths and patient constitutions such as body weight and height(r=0.144, r=0.032). 3) Locations of catheter tips were distributed to the 0.9+/-3.1 cm left to the spinous process, 1.9+/-1.6 cm inferior to the carina ; mostly LLQ of the lung field(51%). 4) During cardiopulmonary bypass, pulmonary artery catheter tips were migrated distally in 93.6% of the cases and the migration lengths were 2.7+/-2.0 cm. 5) There were no major perioperative complications caused by pulmonary artery catheterization. These results suggest that 5 cm withdrawal of pulmonary axtery catheter just before cardiopulmonary bypass can prevent the fatal complication of pulmonary artery rupture owing to its spontaneous distal migration.