Presentation
Out of hospital cardiac arrest. Dilated right ventricle. Confirmed brain death. Pre-transplant assessment.
Patient Data
Suboptimal portable AP radiograph with cut-off of both apices (ICU patient).
Pulmonary artery catheter inserted via right IJV route, passing into the descending right pulmonary artery. The tip is positioned too far distally and ideally to be withdrawn a few centimeters.
ETT in good position. NGT tip projected over the mid thoracic spine and needs to be repositioned.
Left basal consolidation.
Case Discussion
Pulmonary artery (Swan-Ganz) catheters are employed less than they were in the past but still have an important role to play in certain clinical contexts. This patient is brain dead and is being assessed for heart and lung transplantation. The evaluation includes measuring right heart and pulmonary artery pressures.
Ideally the catheter is placed in the right/left main pulmonary arteries, and should not lie more than 1 cm lateral to the mediastinum. If the catheter lies too distally and the balloon is inflated there is a risk of pulmonary infarction.
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