Pulmonary artery catheterization is a procedure permitting evaluation
of pulmonary arterial pressures, pulmonary artery occlusion pressure,
cardiac output, mixed venous oxygen saturation, and volumetric measurements
on the right side of the heart.
- ▪ Pulmonary artery catheter (PAC): A multilumen, balloon-tipped
catheter designed to permit simultaneous measurements of pressure
in the vena cava and pulmonary artery, as well as intermitted measurement
of pulmonary artery occlusion pressure (also called pulmonary capillary wedge
pressure) when the balloon is inflated, and measurement of the blood
temperature at the tip of the catheter.
- ▪ Mixed venous PAC: A PAC equipped with a fiberoptic bundle
and designed to permit oximetric analysis of blood at the tip of
the catheter—typically in the pulmonary circulation.
- ▪ Continuous cardiac output PAC: A PAC equipped with a heating
element permitting continuous evaluation of cardiac output.
- ▪ Volumetric PAC: A PAC designed to measure right ventricular
- ▪ Indications (this is a subject of a great deal of
dispute in recent medical literature, so these indications will
be very limited in scope):
- —Measurement of pulmonary arterial pressures
- —Direct measurement of cardiac output
- —Continuous measurement of cardiac output and/or
mixed venous oxygen saturation
- —Continuous measurement of trends in hemodynamic
- ▪ Contraindications:
- —Friable right heart lesions (ie, clot or valvular
- ▪ Access to the central circulation is as described
in Chapter 36.
- —The PAC is inserted through an appropriately
sized sheath following balloon testing (Figure 38-1) and placement
of a sleeve over the PAC (Figure 38-2), which will permit subsequent
manipulation of the PAC without surface contamination.
- —The PAC is inserted to a depth of approximately
20 cm, at which point the balloon is inflated (Figure 38-3).
- —The PAC is then advanced through the right ventricle
into the pulmonary artery, using waveforms to determine the location
of the tip (Figures 38-4, 38-5, 38-6, 38-7, 38-8, 38-9, 38-10, and 38-11).
- —When the waveform indicates that balloon is wedged
(Figures 38-12 and 38-13), it should be deflated and the sleeve
extended to cover the catheter and locked in place.
- ▪ Complications:
- —See Chapter 36
- —Pulmonary infarction secondary to prolonged balloon
inflation or overinflation
- —Knotting of catheter
PAC prior to insertion laid out with balloon
inflated on large drape.
Sheath threaded over PAC.
PAC inserted into sheath.
Timing of electrocardiographic (ECG) events relative
to pulmonary arterial pressure events.