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Bedside Clinician's Guide to Pulmonary Artery Catheters
W Everett Fox1, Michael Marshall2, Susan M Walters3
1W. Everett Fox is an anesthesiology resident, Department of Anesthesiology, University of Virginia Health System (UVA Health), Charlottesville, Virginia.
Critical Care Nurse
|July 31, 2023
Summary
Pulmonary artery catheter insertion can be challenging due to patient factors. Advanced techniques and imaging improve success rates for right heart monitoring and pacing.
Area of Science:
- Critical Care Medicine
- Cardiovascular Monitoring
- Interventional Cardiology
Background:
- Pulmonary artery catheters (PACs) are crucial for assessing cardiac function, mixed venous oxygenation, and right-sided pressures.
- PACs offer potential for temporary cardiac pacing.
- Understanding PAC insertion techniques is vital for bedside clinicians.
Purpose of the Study:
- To guide clinicians on inserting right heart monitors and devices.
- To identify risk factors and contraindications for difficult PAC insertion.
- To update on novel technologies for intensive care unit (ICU) use.
Main Methods:
- Comprehensive literature review.
- Inclusion of expert clinician insights on underexplored topics.
Main Results:
- Advanced imaging (transesophageal echocardiography, fluoroscopy) aids insertion.
- Specific techniques facilitate pulmonary artery passage.
- New technologies include anchoring pacing catheters and remote pulmonary artery monitoring devices.
Conclusions:
- Risk factors for challenging PAC insertion include atrial fibrillation, dilated atria, reduced ventricular function, pulmonary hypertension, and structural abnormalities.
- Clinicians must master advanced techniques and imaging for successful placement.
- The benefits of PACs for pressure monitoring and pacing generally outweigh the low risk of complications.
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