Misplaced pulmonary artery catheter

Case contributed by Dr Seamus O'Flaherty

Presentation

Postoperative tricuspid valve replacement with pulmonary artery catheter inserted through the right internal jugular vein.

Patient Data

Age: 50 years
Gender: Female

Endotracheal tube in situ with tip at the level of carina. Pulmonary artery catheter coiled in the right atrium with tip in the right ventricle. Right sided intercostal catheter in situ. Pacing wires in situ. Mild bibasal atelectasis. Small right apical pneumothorax.

The patient was in the intensive care unit as part of routine postoperative care. The coiled pulmonary artery catheter was retracted to the level of the cavoatrial junction and the endotracheal tube was retracted three centimeters.

Endotracheal tube tip now lies at the lower level of the clavicle. Right pulmonary artery catheter at the level of the cavoatrial junction. 

The pulmonary artery catheter was re-floated through the tricuspid valve replacement and successfully positioned into the pulmonary artery.

Pulmonary artery catheter has been advanced with the tip correctly positioned in the pulmonary artery. 

Case Discussion

Identification of the misplaced pulmonary artery catheter was suspected prior to the first chest x-ray due to abnormal waveforms and cardiac indices obtained on admission to the intensive care unit postoperatively. The chest x-ray confirmed that it was coiled with the tip laying in the right ventricle. It was carefully retracted so as not to damage the tricuspid valve replacement, and then re-floated into the pulmonary artery successfully.

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