Video Fluoroscopy for Positioning of Pulmonary Artery Catheters in Patients Undergoing Cardiac Surgery

Abstract

In cardiac surgery patients at higher risk for PAC complications, video fluoroscopy facilitated faster and safer catheter flotation and positioning compared with the traditional pressure waveform flotation technique.

Cephalad misplacement of a pulmonary artery catheter in a patient with a preexisting Hickman catheter

“…Normally, placing the patient in a head-down position aids flotation from the RA to the RV, and repositioning the patient to achieve a right lateral tilt, with the head tilted slightly upward, aids flotation from the RV to the PA [ 2 , 3 ]. TEE or fluoroscopy can be used as alternatives to conventional waveform-based PAC placement with expertise hands [ 26 – 28 ]. Both adjunct methods have been shown efficacy in potentially difficult cases.…”

Ultrasound guided pulmonary artery catheter insertion: An alternative to fluoroscopic guidance

“…The abnormal flow can induce the PAC to coil in cardiac chambers such as right atrium and right ventricle or be misdirected to the inferior vena cava. Repeated attempts to retract and redirect the catheter can increase the risk of complications and should be avoided [ 2 ]. The use of fluoroscopic guidance persists in these cases and is often employed in elective procedures in catheterization lab or for femoral point of access.…”

“…The use of fluoroscopic guidance persists in these cases and is often employed in elective procedures in catheterization lab or for femoral point of access. Fluoroscopy when used alongside pressure waveform analysis has been noted to reduce the time to wedge, number of attempts and composite complication rate in patients undergoing cardiac surgery [ 2 ]. In addition, fluoroscopy provides real time visualization that can lead to reduction of catheter malposition and ventricular arrythmias.…”

“…Finally use of fluoroscopy can led to unnecessary radiation exposure to both the patient and the proceduralist. A study highlighting the merits of fluoroscopy for PAC placement also noted an additional exposure to radiation for up to 300 seconds [ 2 ]. Although the dose of radiation received during PAC placement is comparable to diagnostic Xray, it is contributing the cumulative radiation exposure to patients receiving numerous diagnostic imaging test during a critical illness.…”