Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: Methods
Through the introducer, a quadruple-lumen 7-French thermodilution heparin-bonded flotation catheter (ViggoSpectramed, Oxnard, Calif) was inserted. Before entering the femoral vein, the distal lumen of the pulmonary artery catheter was connected to a pressure monitor system (Siemens, Danvers, Mass) and a continuous electrocardiogram was begun. The pulmonary artery catheter was then passed through the introducer to approximately 40 to 45 cm at which time the pulmonary artery catheter balloon was inflated with 1.5 nil of air. Following balloon inflation, the catheter was quickly passed until a pulmonary arterv waveform was obtained. With this approach, the right ventricle waveform usually appeared at approximately 55 cm and a pulmonary artery waveform appeared at approximately 70 cm. Once the pulmonary catheter was felt to be in good position, it was secured in place and covered with a sterile sleeve. The insertion site was then covered with povidone-iodine ointment and a sterile dressing. Following insertion of the catheter, a chest radiograph was obtained to further verify position of the catheter in the pulmonary artery. Each procedure was done without fluoroscopy and in all cases blood pressure was measured continuously by arterial line.
Insertion sites were cared for by our intensive care nursing staff and insertion dressings were changed every 48 h buy tavist online. Similarly, all associated intravenous tubing, infusion fluids, and pressure transducers were also changed every 48 h. Blood samples were periodically aspirated from the pulmonary artery port to obtain pulmonary artery oxygen saturation measurements and this was done only after the pulmonary artery aspiration port was cleaned with povidone-iodine solution. Saline solution was injected into the proximal port of the pulmonary artery catheter for cardiac output determinations as needed.
In all patients, pulmonary artery pressure tracings, electrocardiographic recordings, progress notes, and laboratory data were reviewed from the time of catheter insertion until discharge from the hospital or death. The charts were analyzed looking for ventricular arrhythmias at the time of catheter insertion and evidence of catheter-related septicemia, clinical evidence of deep vein thrombosis and pulmonary embolism, and problems developing at the insertion site such as hemostasis or localized infection.
Category: Respiratory Symptoms
Tags: ards, cirrhosis, copd, pulmonary artery, septic shock, thrombosis