Kosin Medical Journal (고신대학교 의과대학 학술지)

Kosin University College of Medicine (고신대학교 의과대학)
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A double-knotted pulmonary artery catheter with large loop in the right internal jugular vein -A case report-

  • Yoon, Kyoung Sub (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine) ;
  • Kim, Jung A (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine) ;
  • Hong, Jeong In (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine) ;
  • Kim, Jeong Ho (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine) ;
  • Park, Sang Yoong (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine) ;
  • Choi, So Ron (Department of Anesthesiology and Pain Medicine, Dong-A University College of Medicine)
  • Received : 2017.08.17
  • Accepted : 2017.10.16
  • Published : 2018.12.31
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Abstract

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.

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References

  1. Swan HJ, Ganz W, Forrester J, Marcus H, Diamond G, Chonette D. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med 1970;283:447-51. https://doi.org/10.1056/NEJM197008272830902
  2. Lapinsky SE, Richards GA. Pro/con clinical debate: pulmonary artery catheters increase the morbidity and mortality of intensive care unit patients. Crit Care 2003;7:101-3. https://doi.org/10.1186/cc1872
  3. Hadian M, Kim HK, Severyn DA, Pinsky MR. Cross-comparison of cardiac output trending accuracy of LiDCO, PiCCO, FloTrac and pulmonary artery catheters. Crit Care 2010;14:R212. https://doi.org/10.1186/cc9335
  4. Starzyk L, Yao E, Roche-Nagel G, Wasowicz M. Snaring swans: intraoperative knotting of pulmonary artery catheters. Anaesthesiol Intensive Ther 2016;48:66-70. https://doi.org/10.5603/AIT.2016.0013
  5. Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ, Rodriquez Funes VR, et al. Complications associcated with pulmonary artery catheters: a comprehensive clinical review. Scand J Surg 2009;98:199-208. https://doi.org/10.1177/145749690909800402
  6. Colbert S, O'Hanlon DM, Quill DS, Keane P. Swan Ganz catheter--all in a knot. Eur J Anaesthesiol 1997;14:518-20. https://doi.org/10.1097/00003643-199709000-00007
  7. Bottiger BW, Schmidt H, Bohrer H, Martin E. Non-surgical removal of a knotted Swan-Ganz catheter. Anaesthesist 1991;40:682-6.
  8. Karanikas ID, Polychronidis A, Vrachatis A, Arvanitis DP, Simopoulos CE, Lazarides MK. Removal of knotted intravascular devices. Case report and review of the literature. Eur J Vasc Endovasc Surg 2002;23:189-94. https://doi.org/10.1053/ejvs.2001.1591
  9. Georghiou GP, Vidne BA, Raanani E. Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution. Heart 2004;90:e28. https://doi.org/10.1136/hrt.2003.031997
  10. Fibuch EE, Tuohy GF. Intracardiac knotting of a flow-directed balloon-tipped catheter. Anesth Analg 1980;59:217-2.
  11. Bossert T, Gummert JF, Bittner HB, Barten M, Walther T, Falk V, et al. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg 2006;21:292-5. https://doi.org/10.1111/j.1540-8191.2006.00235.x