Difficult placement of a pulmonary artery catheter prior to coronary artery bypass grafting

An analysis of factors influencing pulmonary artery catheter passage through the tricuspid and pulmonary valves

Purpose

A pulmonary artery catheter (PAC) has to pass the tricuspid and pulmonary valves for its proper placement. Although several factors were reported to hinder the placement, there have been no reports to identify the factors that prolong the individual time for passing through each valve.

Method

We individually measured the time required for a PAC to pass through the tricuspid and pulmonary valves. We examined the effect of the following factors on those times: the patient’s age, sex, height, weight, cardiothoracic ratio, tricuspid regurgitation, left ventricular ejection fraction, and the diameters of the sinus of Valsalva and of the sinotubular junction divided by the body surface area which represent the diameter of the aorta. Data were analyzed by multiple linear regression analysis after univariate analysis.

Results

The placement of a PAC was successful in all of 100 patients. The time required to pass through the pulmonary valve was significantly longer than that through the tricuspid valve (15 [10–28] s vs 9 [5–16] s, median [range], P < 0.01). The incidence of ventricular arrhythmias during passage through the pulmonary valve was significantly higher than that through the tricuspid valve (17% vs 0%, P < 0.01). Tricuspid regurgitation and the diameter of sinotubular junction had a significant positive association with the time required to advance a PAC through the pulmonary valve, although there was no significant factors that increased the time required to advance a PAC through the tricuspid valve.

Conclusion

The time required to advance a PAC through the pulmonary valve is much longer than that to pass through the tricuspid valve. The diameter of aortic root and tricuspid regurgitation are significant factors that increased the time required to advance a PAC through the pulmonary valve.

Dilated aortic root influences pulmonary artery catheter placement in anesthetized patients

Purpose

The placement of a pulmonary artery catheter sometimes needs long time by observing the pressure wave, and several factors have been reported to hinder the placement. In the present study, we examined whether enlargement of the aortic root is associated with longer time for the placement.

Method

We examined the time required for the catheter placement. The catheter placement time was defined as the duration of time required for the catheter to float from the CVP position to the pulmonary artery. The catheter placement was performed by one experienced physician. We examined the following factors on the catheter placement time: the patient’s age, height, weight, cardiothoracic ratio, tricuspid regurgitation, ejection fraction and the diameter of aortic annulus, sinus of Valsalva, sinotubular junction, and proximal ascending aorta. These diameter values were divided by body surface area (BSA) to equalize among different physical sizes. The data were analyzed by multiple linear regression analysis after univariate analysis.

Results

The univariate analysis showed that ejection fraction and aortic annulus/BSA, sinus of Valsalva/BSA, and sinotubular junction/BSA correlated with the catheter placement time (P = 0.079, 0.030, 0.029, and 0.025, respectively). Since the three aortic root values correlated with each other, we chose the sinotubular junction/BSA for the following multivariate analysis, because of the highest P value. The multivariate analysis showed that sinotubular junction/BSA had a significant positive association with the placement time (P = 0.048).

Conclusion

The present study showed that enlargement of the aortic root is associated with long placement time of the catheter.

An analysis of the factors influencing pulmonary artery catheter placement in anesthetized patients

Background:

Pulmonary artery catheters are usually placed by resident anesthesiologists with pressure wave monitoring from educational point of view. In some cases, the placement needs longer time or is difficult only by observing the pressure waves.

Aims:

We sought to examine the time required for the catheter placement in adult patients and determine factors influencing the placement.

Settings and Designs:

Prospective, observational, cohort study.

Methods:

We examined the time required for the catheter placement. If the catheter is placed in longer than 5 min, this could be a difficult placement. We examined the effect of the patient's age, body mass index, cardiothoracic ratio (CTR) and tricuspid regurgitation, left ventricular ejection fraction (LVEF) and training duration of a resident on the difficult catheter placement. Next, we excluded the difficult cases from the analysis and examined the effect of these factors on the placement time.

Statistical Analysis:

The data were analyzed by logistic regression analysis to assess factors for the difficult catheter placement and multiple linear regression analysis to evaluate the factors to increase the placement time after univariate analyses.

Results:

The difficult placement occurred in 6 patients (5.7%). The analysis showed that LVEF was a significant factor to hinder the catheter placement (P = 0.02) while CTR was a significant factor to increase the placement time (P = 0.002).

Conclusion:

LVEF and CTRs are significant factors to be associated with the difficult catheter placement and to increase the placement time, respectively.