Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: Methods
Since its introduction into clinical use, the pulmonary artery catheter has helped physicians to understand and manage the rapid and potentially disastrous changes in cardiopulmonary physiology that may occur in the critically ill. As with any new instrument, the increased usage of the catheter resulted in complications related to its insertion. However, the risk of many of these complications declined in the 1980s, probably because of better physician awareness and supervision of insertion technique, and improved catheter design and care. There are many potential access routes to the pulmonary artery. Each site has advantages and disadvantages to be considered. In the intensive care unit (ICU), the pulmonary artery catheter is usually inserted via the internal jugular and subclavian vein because of operator preference and previous experience with these routes. Under certain clinical circumstances, intravenous access bv these routes is not feasible or inordinately risky and other sites must be chosen. At Bronx Municipal Hospital Center (BMHC), we often choose the femoral vein for nonfluoroscopic pulmonary arterv catheter insertion when clinical conditions preclude internal jugular or subclavian vein catheterization.canadian health mall This report summarizes our experience with using the femoral vein for pulmonary arterv catheterization.
Data were collected from 33 consecutive patients who underwent pulmonary arterv catheterization via a femoral vein. Five of the 33 patients studied had more than one femoral vein pulmonary artery catheter during their hospital course. Overall, 39 attempts at femoral vein pulmonary arterv catheterization were made in the 33 patients studied. Twenty of the patients were male and 13 were female. The patients ranged in age from 24 to 83 years, with the mean age 56 years. The condition at the time of catheterization was classified as septic shock (11 = 22). gastrointestinal bleed (n = 7). cardiogenic shock In = 1 ), cardiac tamponade (n = 1), preoperative (n = 1), or drug overdose (n = 1 ). The clinical circumstances that were important in selecting the femoral vein as the route of catheterization included severe coagulopathy (n = 29), severe pulmonary compromise (n = IS), abnormal neck anatomy (n = 6). and inability to lie* supine* (n = 1). Twenty of the 33 patients had at least two of these conditions (Table 1).
We retrospectively reviewed the charts of all patients receiving femoral vein pulmonary artery catheterization in the medical ICU between July 1, 1988 and June 30, 1992. All catheters that were inserted bv medical residents (PGY 2 or 3) or ICU/CCU fellows were done so under the direct supervision of the ICU Director.
In all cases, the femoral triangle was cleaned with povidone-iodine solution, the patient was covered with sterile drapes, and physicians wore masks, caps, sterile gloves, and gowns.
The femoral vein was then punctured percutaneously one finger breadth below the inguinal ligament and approximately 1 cm medial to the femoral pulse with a 21-gauge “finder” needle. Once the vein was localized, an 18-gauge needle was placed directly adjacent to the finder needle and via Seldinger technique an 8-French Swan-Ganz catheter introducer (Sterile Concept, Richmond, Yra) was placed.
Table 1—Patient Characteristics
|Patient/Sex/ Age, yr||Diagnosis||Indication for Femoral||MedicalHistory||No. of Days in Place||Compl||F/UDays|
|l/F/74||Septic shock||C, ARDS||DM, HTN||3||—||23|
|2/M/37||Septic shock||C, ARDS||COPD, ALD||3t||—||10|
|3/M/32||Septic shock||C, ARDS||HIV||3t||19 l>eat VT||17|
|4/F/73||Septic shock||C, ARDS||DM, HTN||1||—||1|
|5/M/25||Septic shock||C, ARDS||ALD||3||–||5|
|6/F/31||Septic shock||C, ARDS||HIV, NHL||3||—||7|
|8/F/38||Septic shock||С, ARDS||ALD, P||3$||—||21|
|9/F/61||Septic shock||I||COPD, H||3||—||11|
|10/F/74||Septic shock||C, ARDS||COPD, DM, CAD||3||—||18|
|ll/M/42||GI bleed||C, ARDS||Cirrhosis||3||—||76|
|12/M/39||Septic shock||C, ARDS||AIDS, CVA||3||—||14|
|13/M/72||Septic shock||C, ARDS||COPD, CAD, IBD||3t||—||30|
|15/F/43||Septic shock||С, ARDS||ALD, P||3||—||9|
|16/F/24||Septic shock||С, AH||SLE||3t||—||12|
|17/M/83||Septic shock||С, ARDS||CVA||3||–||15|
|18/M/58||GI bleed||С||COPD, H||3||—||11|
|19/M/55||GI bleed||С, ARDS||HTN||3||—||30|
|21/F/63||Septic shock||С, ARF||DM, RA, HTN||3||—||21|
|22/M/65||Septic shock||С, ANA||DM, HTN, AF||3||—||43|
|23/F/41||Septic shock||С, ANA||HIV||3||—||27|
|27/F/80||Tamponade||С||Lung ca||0||17 beat VT||0|
|28/F/65||Septic shock||С, ANA||COPD||3||—||10|
|33/M/70||Cardio shock||ANA||Esophageal Ca||0||10 beat VT||0|
Category: Respiratory Symptoms
Tags: ards, cirrhosis, copd, pulmonary artery, septic shock, thrombosis