Indications for Catheterization 

 

Settings in which to use a central venous catheter:

      Central venous pressure measurements can provide a good assessment of right- sided cardiac function and vasculature volume status.  In patients without cardiac or pulmonary disease, central venous pressure can also be used to estimate left-sided cardiac function.  Central venous catheters are used in the operating room and in other areas of the hospital for many other reasons as well:

  1. Monitoring central venous pressure in patients with hypovolemia and shock
  2. Infusion of caustic drugs
  3. Total parenteral nutrition (TPN)
  4. Aspiration of air emboli
  5. Insertion of transcutaneous pacing leads
  6. Venous access in patients with poor peripheral veins

Contraindications to central venous catheter use :

        Some rare contraindications to central venous catheter placement include renal cell tumor extension into the right atrium, or large tricuspid valve vegetations.  Anticoagulants are a relative contraindication, as is a previous carotid endarterectomy on the ipsilateral side as the catheter.

 

Settings in which to use a pulmonary artery catheter:

      Central venous catheters can assess cardiac function fairly accurately in a healthy patient with concordant right and left heart function, however when there exists a dissociation between right and left heart function, a pulmonary artery catheter is necessary to “look” at left sided cardiac function alone.  Besides providing fundamental hemodynamic information for a patient, pulmonary artery catheters can be used for all of the following:

  1. Measure cardiac output via the thermodilution method
  2. Assess the volume status of a patient
  3. Measure mixed venous oxygen content
  4. Derive hemodynamic indices
  5. Detect venous air embolism 

Some specialized PACs can also be utilized in the following:

  1. Allow drug infusions
  2. Perform angiography
  3. Obtain intracardiac EKGs
  4. Perform atrial and ventricular pacing
  5. Calculate ejection fraction

 

 

Contraindications to pulmonary artery catheter use:

      Relative contraindications include Wolff-Parkinson-White syndrome and Ebstein’s malformations (given that PACs can induce arrhythmias)  and complete left bundle branch block (due to the risk of complete heart block.)

 

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