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As with the central venous catheter placement and use, pulmonary artery catheters are not without risk to the patient.
- Arrhythmias: Arrhythmias are the most common complication during the positioning and removing pulmonary artery catheters. Temporary ectopy arises from the catheter irritating the endocardium of the right ventricle. Studies have shown a 12-48% incidence of transient PACs and 33% incidence of ventricular tachycardia during placement of pulmonary artery catheters. Usually, this phenomenon is transient, and does not require intervention with IV lidocaine. To decrease incidence of these arrhythmias, the operator should move quickly through the right ventricle while advancing the catheter, with the balloon inflated.
- Catheter knotting : Coiling of the catheter can occasionally occur within the right atrium or ventricle during PAC insertion. In rare cases, the coiling can incorporate intra-cardiac structures, such as papillae. To prevent knotting from occurring, the balloon should be deflated and the catheter pulled back if characteristic waveforms do not appear at the expected length.
- Pulmonary artery perforation : This catastrophic, but thankfully rare complication carries a mortality rate of 50-70%. Risk factors identified include advanced age, hypothermia, and pulmonary hypertension. Most often, artery rupture is due to distal placement of the catheter tip within the pulmonary vasculature and “overwedging.” One clear way to reduce this risk is to minimize the number of balloon inflations. If pulmonary artery rupture is suspected (hemoptysis, systemic signs of hemorrhage) treatment is largely supportive; intubation of the unaffected lung, PEEP, reversal of heparin, and blood and fluid replacement.
- Infection: As with any invasive catheter, there exists a risk for bacteremia or fungemia to occur. If infection is suspected, the patient should be cultured, treated with broad-spectrum antibiotics, and any indwelling catheters removed or replaced if possible.
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