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

[Click here to toggle visibility of the answers]

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
 

References

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.