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CARDIOVASCULAR ANESTHESIA

Management of an Unusual Complication During Placement of a Pulmonary Artery Catheter

Department of Anesthesiology, School of Medicine, St. Louis University, St. Louis, Missouri

Address correspondence and reprint requests to Nahel N. Saied, MB, BCh, St. Louis University Hospital, Department of Anesthesiology, 3635 Vista Ave. at Grand Blvd., St. Louis, MO 63110. Address e-mail to saiedn{at}mac.com

We describe an unusual complication during flotation of a pulmonary artery catheter through a preexisting percutaneous introducer sheath. A malfunctioning pulmonary artery catheter, which was placed through an introducer sheath in the right internal jugular vein, was removed. Attempts at repositioning a second pulmonary artery catheter met with resistance, and we were unable to either advance or withdraw it. Chest radiograph showed a bent introducer sheath going from the right internal jugular vein into the right subclavian vein and a pulmonary artery catheter loop. Under continuous fluoroscopy, the introducer sheath and the pulmonary artery catheter were withdrawn as one unit, which resulted in relaxation of the acute angulation in the introducer sheath and allowed the pulmonary artery catheter to unfold, thus facilitating their complete extraction. We conclude that complications may occur during placement of a pulmonary artery catheter through a well positioned introducer sheath and that fluoroscopy is a valuable tool for safe management of such a complication.

IMPLICATIONS: Pulmonary artery catheters are widely used to manage critically ill patients but can be associated with various complications. This case report describes the occurrence and management of a highly unusual complication associated with the placement of a pulmonary artery catheter through a previously well positioned introducer sheath.

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