Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: Discussion
In the 11 patients without septic shock, two of them became febrile while they had a femoral Swan-Ganz catheter in place. In both of these cases, the fever was attributable to nosocomial pneumonia as these patients developed new lung infiltrates and purulent sputum. Both of these patients defervesced after being started on regimens of vancomycin and a third-generation cephalosporin. Swan-Ganz catheter tips were sent for culture in both these patients after the catheter was removed and in both instances no growth occurred. Blood cultures were obtained in both cases and were negative. The femoral vein insertion site in both cases showed no evidence of swelling or redness. In patients with and without sepsis, all catheters inserted via the femoral vein were removed within 3 days. www.canadian-familypharmacy.com
None of the 33 patients studied had clinical evidence of deep venous thrombosis or pulmonary emboli. The follow-up period ranged from 1 to 76 days.
The complications of pulmonary artery catheterization are well known. In our ICU we commonly use the internal jugular or subclavian veins to gain access for pulmonary artery catheter insertion. When clinical circumstances such as a severe coagulopathy, abnormal neck anatomy, or inability to lie flat preclude the use of these veins, we use the femoral vein to obtain intravenous access because of its ease of insertion and low complication rate. In patients with severe coagulopathies, the subclavian vein approach should not be used because it is a noncompressible blood vessel and hemothorax, which usually requires surgical intervention, may result. Internal jugular puncture, though possible, becomes more risky because the most common complication associated with this approach is inadvertent carotid artery puncture. Severe pulmonary compromise alone was not an indication for the femoral approach unless it was accompanied by a severe coagulopathy or the patient could not tolerate lying flat.
In 37 of 39 attempts, we were able to successfully catheterize the pulmonary artery via the femoral vein without using fluoroscopy. This success rate compares favorably with both the internal jugular and subclavian approaches. We believe our high success rate was due to careful supervision of our residents and fellows by the ICU Director.
Category: Respiratory Symptoms
Tags: ards, cirrhosis, copd, pulmonary artery, septic shock, thrombosis