TY - CHAP M1 - Book, Section TI - Use of Monitors: Pulmonary Artery Catheter A1 - Bailin, Michael A1 - Spanakis, Spiro PY - 2000 T2 - Guidelines AB - |PrintUse of Monitors: Pulmonary Artery CatheterComments by David E. Longnecker, MD, FRCAOrg/(Date)PopulationRecommendationCommentsSourceASA 2003 (still current)Adults with significant cardiovascular disease and/or risk of significant organ dysfunction.1. Effectiveness: Clear, highly reliable evidence of improved outcomes for broad patient populations does not exist. Therefore, expert opinion is used to interpret the existing literature.PA catheterization, in the form of balloon-tipped pulmonary artery catheters is rarely used in infants and small children due to technical mechanical issues.Anesthesiology 2003; 99:988-1014[go to full text of guideline]2. Hazards: Hazards associated with PA vascular access include carotid or subclavian artery puncture, bleeding, pneumothorax and air embolus. Those associated with catheter positioning include dysrhythmias and PA perforation. Hazards associated with catheter residence include thrombosis, thrombophlebitis, pulmonary embolus and infarction, PA rupture or sepsis.The incidence of complications is often associated with experience of the provider and the use of ancillary technologies, such as ultrasonic guides, full-body surgical drapes during placement, etc.3. Three factors should guide appropriateness of PA catheter monitoring: patient characteristics (severity of disease), surgical procedure (invasiveness, potential for hemodynamic instability and subsequent organ dysfunction, etc.), and practice setting (knowledge, experience and skills of the providers and intensive care staff, availability and experience with alternative minimally invasive techniques such as TEE, etc.Decision making requires interpretation of a variety of judgment factors, rather than reference to a definitive clinical trial that applies across large populations.4. Routine PA catheterization is inappropriate in low (ASA 1-2) or moderate (ASA 3) risk patients.5. PA catheterization may be indicated in high risk (ASA 4-5) patients or procedures (anticipated large fluid or hemodynamic changes that may lead to organ damage or failure). SN - PB - The McGraw-Hill Companies, Inc. CY - New York, NY Y2 - 2024/03/28 UR - accessanesthesiology.mhmedical.com/content.aspx?aid=5010001 ER -