Department of Anesthesiology and Pain, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
BMC Anesthesiol. 2021 Jun 1;21(1):73. doi: 10.1186/s12871-021-01254-4.
Pulmonary artery catheter insertion is a routine practice in high-risk patients undergoing cardiac surgery. However, pulmonary artery catheter insertion is associated with numerous complications that can be devastating to the patient. Incorrect placement is an overlooked complication with few case reports to date.
An 18-year-old male patient underwent elective mitral valve replacement due to severe mitral valve regurgitation. The patient had a history of synovial sarcoma, and Hickman catheter had been inserted in the right internal jugular vein for systemic chemotherapy. We made multiple attempts to position the pulmonary artery catheter in the correct position but failed. A chest radiography revealed that the pulmonary artery catheter was bent and pointed in the cephalad direction. Removal of the pulmonary artery catheter was successful, and the patient was discharged 10 days after the surgery without complications.
To prevent misplacement of the PAC, clinicians should be aware of multiple risk factors in difficult PAC placement, and be prepared to utilize adjunctive methods, such as TEE and fluoroscopy.
肺动脉导管插入术是高危心脏手术患者的常规操作。然而，肺动脉导管插入术与许多并发症相关，这些并发症可能对患者造成严重影响。目前，只有少数病例报告提到导管位置不正确是一种被忽视的并发症。
一名 18 岁男性患者因严重二尖瓣反流接受择期二尖瓣置换术。该患者曾患有滑膜肉瘤，并在内侧颈静脉插入了 Hickman 导管进行全身化疗。我们多次尝试将肺动脉导管放置在正确的位置，但均未成功。胸部 X 线片显示肺动脉导管弯曲并指向头侧。成功取出肺动脉导管，患者在手术后 10 天出院，无并发症。
为了防止 PAC 位置不当，临床医生应该了解在困难的 PAC 放置中存在多种危险因素，并准备好使用 TEE 和透视等辅助方法。
