Australian Regenerative Medicine Institute

Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: Results

Femoral Vein Pulmonary Artery Catheterization in the Intensive Care Unit: ResultsThe electrocardiographic recordings from the catheter insertion were reviewed and the permanent tracings were interpreted independently by both of the authors. Catheter-related septicemia was defined as a septic episode in which no other cause for positive blood cultures could be found and for which the catheter-tip culture grew the same organism found on peripheral blood cultures. All patients who became febrile had two sets of peripheral blood cultures drawn, and if the catheter was believed to be the source of infection, it was removed. In all febrile patients, when the catheter was removed, the site was cleaned with povidone-iodine, and the distal 2 to 3 cm of the catheter was clipped with sterile scissors and sent for culture. All catheter tips sent for culture were incubated in a broth medium designed to grow both aerobes and anaerobes. Cultures were reported to be negative only after 14 days without bacterial growth. If a catheter was required longer than 3 days, it was removed and a new catheter was inserted on the other side. Thirty-three patients underwent 39 attempts at femoral vein pulmonary artery catheterization.

This was successful in 37 cases, a 95 percent success rate. Cannulation of the femoral vein was successful in all patients. Four patients had inadvertent arterial punctures with the “finder” needle and in all four of them the femoral vein was cannulated on the second attempt. Four patients required two femoral vein pulmonary artery catheters and one had three catheters. In 3 of the 39 attempts (7.7 percent), catheter placement into the right ventricle led to transient ventricular tachycardia and was associated with catheter coiling in the ventricle. All these arrhythmias resolved by pulling the catheter back into the right atrium and none required treatment with lidocaine. No local complications such as hematoma, hemorrhage, or urologic injury occurred at the insertion site. Of our 33 patients, 22 of them were believed to be in septic shock at the time of Swan-Ganz insertion. All of these patients with sepsis were initially treated with an aminoglycoside and a semisynthetic penicillin. Of these 22 patients with sepsis, 1 died within 24 h from overwhelming sepsis. In the remaining 21 patients with septic shock, which accounted for 27 femoral vein pulmonary artery catheters, in no instance did an episode of suspected line sepsis occur that required removal of the femoral vein pulmonary artery catheter. In these 21 patients with sepsis, there were 9 episodes where the patient failed to defervesce despite broad-spectrum antibiotic therapy and had a femoral pulmonary artery catheter in place. In these nine instances, the source of fever was attributable to either persistent pneumonia or urosepsis and for this reason the pulmonary artery catheter was not immediately withdrawn. None of these nine patients had evidence of swelling or erythema at the femoral vein insertion site. In these nine instances of persistent fever, the pulmonary artery catheter tip was sent for culture after its removal. In none of these cases did the catheter tip grow an organism. Blood cultures from these nine patients were positive in two cases. In both these cases the sputum and blood had identical organisms and sensitivities

Category: Respiratory Symptoms

Tags: ards, cirrhosis, copd, pulmonary artery, septic shock, thrombosis