College Answer

1.  Pulmonary infarction
2.  Pulmonary artery rupture
3.  Right ventricular perforation

Discussion

In brief:

• Same as CVC:
  • Perforation of SVC
  • Hemothorax, pneumothorax
  • Atrial fibrillation
• Unique to PA catheter
  • Ventricular Arrhythmia
  • Thromboembolic events (the catheter is a nidus for clot formation)
  • Mural thrombi in the right heart (up to 30%)
  • Air embolism from ruptured balloon
  • Pulmonary infarction
  • Endocarditis of the pulmonary valve ( 2%)
• Right bundle branch block
  • If you already have LBBB, this causes complete heart block
  • If you are lucky, it is a transient phenomenon and you only need to pace them transcutaneously for a brief period. If you are unlucky, you have injured the AV node, and the patient needs prolonged transvenous pacing
• Knotting on structures or on itself ( ~ 1%)
  • If it has gone into the right ventricle by 25-30cm and its still not in the pulmonary artery, you start to worry
• Damage to the valves
  •  Never pull the catheter back with the balloon inflated! You could tear the valve leaflets
  • The RV can be perforated, particularly a dilated weak-walled RV
  • The RA can be perforated (perhaps even more easily)
• Pulmonary artery rupture: 0.2% risk,  30% mortality
  • Risk factors: pulmonary hypertension, mitral valve disease, anticoagulants and age over 60