Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: Conclusion
Three of our patients had ventricular arrhythmias during catheter insertion which were secondary to coiling of the catheter in the right ventricle. This was determined by carefully noting the appearance of the waveform pattern and the length of catheter inserted at the time. In two of these cases, catheter coiling in the right ventricle was attributed to the patients’ severe low-flow state. Both of these patients were hypotensive: one from cardiogenic shock and the other from cardiac tamponade. A possible explanation for failing to cannulate the pulmonary artery in both of these cases is that the resulting low-flow state impeded the normal tendency of the flotation catheter to pass into the right ventricular outflow tract. In both of these patients, we decided to forego attempts at femoral vein Swan-Ganz catheterization because we believed the risk of arrhythmia was too high without the use of fluoroscopy. Both of these patients died of refractory shock and acidosis within 12 h. Our low incidence of arrhythmias compares favorably with other studies. mycanadianpharmacy.com
Known complications of femoral vein catheterization include local problems such as bleeding and hematoma formation, catheter-related septicemia, and the development of deep venous thrombosis. In our study, local complications did not occur despite the fact that many of our patients had coagulopathies and on four occasions the femoral artery was entered inadvertently with the “finder” needle. We believe that careful technique using a small 21-gauge “finder” needle to localize the femoral vein accounted for this result.
Clinical evidence of line sepsis was not present in any of our patients, which is in keeping with other studies evaluating femoral vein catheterization.’ In 1992, the incidence of line sepsis in our ICU involving internal jugular and subclavian vein catheterization was 1 percent. We believe our low infection rate during this study occurred because all catheters were placed with careful sterile technique, meticulously maintained, and most importantly, were removed within 72 h. Additionally, our 22 patients with clinical evidence of sepsis were all initially treated with broad-spectrum antibiotics that possibly helped to prevent catheter-related infection in this group. We have no reason to believe that the groin site or catheter contributed to ongoing infection in any of our patients with new or persistent fever. In all of these patients, Swan-Ganz catheter tip cultures were negative and the catheter site was neither swollen nor erythematous. Blood cultures were negative in all but two of these patients. In these two patients, the positive blood cultures were caused by pneumonia and not catheter related.
Both deep venous thrombosis and pulmonary emboli are potential complications of femoral vein catheterization. These complications are more likely with prolonged catheter use. Because of our concern with the development of deep venous thrombosis and pulmonary emboli with catheter use greater than 3 days, we removed all catheters within 72 h. Our study showed no clinical evidence of deep venous thrombosis or pulmonary emboli. The use of heparin-bonded catheters, the removal of all catheters within 72 h, and the fact that many of our patients already had severe coagulopathies likely accounts for this finding.
We conclude that femoral vein pulmonary artery catheterization done by experienced personnel is highly successful without fluoroscopy. When it is used for less than 72 h, its use is associated with a very low incidence of complications such as infection and thromboembolism. Thirdly, we do not know the safety of femoral vein catheterization for greater than 72 h or the incidence of subclinical deep venous thrombosis. Further investigations are necessary to answer these questions.
Category: Respiratory Symptoms
Tags: ards, cirrhosis, copd, pulmonary artery, septic shock, thrombosis