Recording the right atrial electrogram through the fluid column of a pulmonary artery catheter

Analysis of the cardiac rhythm in patients with ventricular and supraventricular tachycardia can be difficult because P-waves tend to be obscured by other components of the ECG. Recording of the intracavitary electrogram by means of pacing wires and the use of esophageal leads can be very helpful under these circumstances. Because a number of these patients are monitored with pulmonary artery catheters, we developed a method to obtain the atrial electrogram using the fluid column of the pulmonary artery catheter as an electrical conductor. Only slight modifications of the ECG equipment were necessary.     

An unusual position of a Swan-Ganz catheter

Placement of a Swan-Ganz catheter can cause many complications. This case report presents a new complication of Swan-Ganz catheter insertion-placement of the Swan-Ganz catheter tip in the coronary sinus.Swan-Ganz is a registered trademark of the American Edwards Company, Inc.     

The pulmonary artery catheter

First developed more than 20 years ago as a research tool for investigations of myocardial infarction, the pulmonary artery or Swan-Ganz catheter has gained general usage as a valuable clinical tool. Its development paralleled the rapid growth of technological advancements in clinical medicine. Rapid incorporation of technological advancements into clinical practice, however, is not without risk. Care must be taken to assure that clinicians possess the understanding of both basic concepts and requisite hardware to provide quality patient care. Equipment selection and calibration, patient selection, data interpretation, potential complications, troubleshooting, and procedure limitations must all be considered. Broader application of the Swan-Ganz catheter in surgery, anesthesiology, and critical care as well as in cardiology has provided information on hemodynamics that has had considerable impact on diagnostics as well as on therapy for patients with a wide variety of clinical conditions.     

The pulmonary artery catheter

The pulmonary artery catheter (PAC) has been widely used for monitoring of critically ill patients over the years, but with advances in less invasive monitoring techniques, notably echocardiography, there are fewer indications for PAC insertion. Nevertheless, the PAC provides simultaneous monitoring of pulmonary artery pressures, cardiac filling, cardiac output and mixed venous oxygen saturation, and still has an important role in complex cases. Adequate and continued training are required to ensure that PAC-derived data are correctly interpreted and applied.     

A journey through heart valve surgery

It is evident that valvular surgeries have made countless advances since the first valve surgery in 1925 when Dr Henry Souttar operated on a woman with mitral stenosis. Patients in the 21st century have a better chance of surviving as a result of these advances. In addition to providing high-quality health care to patients, educating patients and their families regarding the disease processes, symptoms, diagnosis, types of valve surgeries, different approaches, complications, nonsurgical care, recovery, and lifestyle changes is an instrumental component to a successful recovery.     

Pulmonary collapse — An unusual complication of pulmonary artery catheterization

A case of collapse of the right middle and lower lobes associated with pulmonary artery catheterisation is described. Possible mechanisms are discussed.     

Improving the accuracy of pulmonary artery catheter measurements

Pulmonary artery pressures and arterial pressures are important hemodynamic measurements utilized in clinical management decision making for critically ill patients. Studies have demonstrated a concerning rate of measurement error, often due to technical errors. Zeroing, leveling, and dynamic response testing are essential components of assuring the quality of measurements. This article describes a multilevel approach to assuring the accuracy of measurements. It includes the physics underlying each of these principles, criteria for judging the efficacy of the dynamic response, and clinically applicable methods for measuring the natural frequency and damping coefficient of pressure monitoring systems.     

Controversies in the use of the pulmonary artery catheter

The pulmonary artery catheter (PAC) has been in use for more than 30 years. The amount and detail of hemodynamic information provided by the PAC cannot be matched by any other single technology. Whether or not this information makes a difference in the clinical outcomes of critically ill patients is uncertain, however. The Pulmonary Artery Catheter Consensus Conference scrutinized the available research data on the catheter and provided guidelines for clinicians on its use. This article summarizes the controversy and the guidelines available for use of the PAC. It notes the need for further research on patient outcomes.     

Hypotension secondary to balloon inflation of a pulmonary artery catheter

Inflation of a balloon-tipped catheter for measurement of pulmonary artery wedge pressure caused a decrease in systemic arterial blood pressure in a mechanically ventilated patient after pneumonectomy. Obstruction by the balloon of a significant proportion of the cross-sectional area of the pulmonary circulation results in increased right ventricular afterload with subsequent decreased cardiac output and left atrial pressure. This decreased left atrial pressure can be measured accurately by the inflated balloon-tipped catheter but may be falsely low.