Question 6.5

List three serious complications, relating to the pulmonary circulation that can be directly attributed to the use of a pulmonary artery catheter.

College Answer

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

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

This a full-text version of the seminal paper from 1970:

Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D (August 1970). "Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter". N. Engl. J. Med. 283 (9): 447–51.

A manufacturer (Edwards) offers some free information about the PA catheter on their product page.

The PA catheter section from The ICU Book by Paul L Marino (3rd edition, 2007) is a valuable read.

Additionally, UpToDate has an article on PA catheter complications.