Canadian Journal of Anesthesia 51:1010 (2004)
© Canadian Anesthesiologists' Society, 2004
Cardiothoracic Anesthesia, Respiration and Airway
Images in Anesthesia: Accidental knot formation of a pulmonary artery catheter
Tomohiro Matsuda, MD,
Satoki Inoue, MD,
Sha Keiichi, MD and
Hitoshi Furuya, MD
Nara, Japan
THE authors present the photograph of a pulmonary artery catheter (PAC) knot, which formed accidentally in a cardiac surgical patient. The insertion was performed by a junior resident. Placement was not established by advancing the catheter up to 75 cm from the right internal jugular vein insertion site despite multiple attempts. An attempt to withdraw the catheter was made; however, it proved impossible. Fluoroscopy revealed a knot in the PAC. Consequently, the knot was untied by the surgeons during intracardiac manipulations (Figure
). It seems that inexperience and an excessively deep insertion of the PAC were the main contributors to the formation of a knot. According to the typical distance between puncture site and pulmonary artery occlusion position, insertion to 75 cm was excessive and, unfortunately, sufficient to make an intracardiac loop or knot.1 Inexperienced operators tend to over-advance a PAC when its placement is difficult. Moreover, forced withdrawal of a knotted or looped PAC might cause formation of another or new knot with a simultaneously indwelling central venous catheter, especially in the case of a double cannulation.2 We hope that this report will serve as a useful reminder for clinicians, specially those with less experience in PAC insertion.
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FIGURE The knot was pulled out of the atrium during cardiopulmonary bypass. The circumferential black band seen on the catheter is the 10 cm indicator marking.
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References
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1 Mark JB, Slaughter TF, Reves JG. Cardiovascular monitoring. In: Miller RD (Ed.) Anesthesia 5th ed. Philadelphia: Churchill Livingstone; 2000: 1117–1206.
2 Kranz A, Mundigler G, Bankier A, Daneschvar H, Pacher R, Siostrzonek P. Knotting of two central venous catheters: a rare complication of pulmonary artery catheterization. Wien Klin Wochenschr 1996; 108: 404–6.[Medline]
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