The use of flow-directed balloon-tipped pulmonary catheters for the monitoring of hemodynamic parameters in high-risk and critically ill patients is well accepted and widely used. The more common early complications include local and systemic infections, balloon rupture, and arrhythmias. The more serious but less frequent complications include pulmonary arterial occlusion, infarction, and pulmonary artery rupture. The vast majority of these complications are noted during or soon after catheter placement. The reported late complications are asymptomatic valvular damage or vascular thrombus discovered at autopsy. This case illustrates two serious complications of pulmonary artery catheters: the initial pulmonary infarction followed by the development of two pulmonary artery pseudoaneurysms.
In the literature, three cases of pseudoaneurysms from balloon-tipped catheters have been reported. Only one, however, was proven by pathologic inspection. To our knowledge, this represents the only case of multiple lesions, thus leading to the assumption of metastatic neoplasm.
Currently there are several ways to minimize the occurrence of a pseudoaneurysm with infarction after the use of a Swan-Ganz catheter. At the time of introduction, the balloon is inflated in the right atrium and the catheter is floated to the pulmonary artery and pulmonary artery- occluded position. The wedge position is confirmed by oximetry. The pressure is recorded and the balloon is deflated so that a pulmonary artery tracing is recorded. If there is good correlation between the pulmonary artery and the diastolic pressure, and the pulmonary wedge pressure, further inflation of the balloon in the pulmonary artery to measure the wedge pressure can be avoided. In the majority of cases, a pulmonary artery mean pressure or a pulmonary artery diastolic pressure provides sufficient clinical information to assess the adequacy of left heart filling pressures after these correlations are made. It is important, however, to always assess the waveform such that you can detect unexpected distal migration of the catheter. If the pulmonary artery diastolic pressure does not correlate with the wedge, and wedge pressure measurements are necessary, and if an unusually small volume of air is required to inflate the balloon, an excessively distal catheter placement should be suspected. buy levitra 20 mg
The incidence of pulmonary infarction associated with the use of pulmonary artery catheters continues to be significant, as high as 7.2 percent in some series. Followup evaluation for delayed vascular complication should be considered regularly, particularly in those at a high risk, eg, patients with pulmonary hypertension or who show evidence of pulmonary infarction or pulmonary artery rupture. If solitary or multiple nodular densities develop in an area of lung previously subjected to pulmonary artery catheterization, such lesions should be evaluated for their vascularity prior to any invasive diagnostic procedure.