[HSF] Pulmonary Artery Catheters !

Fri Nov 3 16:53:18 EST 2006

Don,
  I totally agree and should have also mentioned that I always want the anesthesiologist to position the tip of the Swan just after the pulmonary valve.  I never want to see the wedge, ever.  Even so, I occasionally will notice the Swan has migrated into the wedge position.  I'll then soundly chastise the anesthesiologist (usually new) so that they know just how dangerous a situation this can be.
Hal 

-----Original Message-----
From: donross at bigpond.com
To: OpenHeart-L at lists.hsforum.com
Sent: Fri, 3 Nov 2006 4:32 PM
Subject: Re: [HSF] Pulmonary Artery Catheters !

This is a complication from which we have had fatal outcomes as well. 
Since putting in strict rules prohibiting the performance of wedge pressures on heparinised patients there have been no more such incidents. 
In my patients, wedge pressure measurements are totally forbidden. 
Don 
On 04/11/2006, at 7:03 AM, Salerno, Tomas wrote: 

> This is the Abstract on our paper: 
> 
> 
> Massive endobronchial hemorrhage due to balloon-tipped catheter > rupture of a branch of the pulmonary artery in a fully heparinized > patient undergoing cardiopulmonary bypass is potentially lethal. > Death occurs due to asphyxiation. Endobronchial intubation (double-> lumen endotracheal tube) appears to be a simple and effective > method for control of the airway and tamponade of the bleeding > site, which allows for completion of the surgical procedure until > protamine sulphate reversal can be achieved. 
> 
> 
> 
> Tomas 
> 
> PMID: 6830370 [PubMed - indexed for MEDLINE 
> -----Original Message----- 
> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l-> bounces at lists.hsforum.com] On Behalf Of prasannasimha 
> Sent: Friday, November 03, 2006 12:27 PM 
> To: OpenHeart-L at lists.hsforum.com 
> Subject: Re: [HSF] Pulmonary Artery Catheters ! 
> 
> Not available online. Can you send the article to my email. 
> What is the summary of the paper ? 
> Prasanna 
> 
> Salerno, Tomas wrote: 
>> We reported on this subject: 
>> 
>> Cervenko FW, Shelley SE, Spence DG, Charrette EJP, Salerno TA: >> Massive endobronchial hemorrhage during cardiopulmonary bypass: >> Treatable complication of bloon-tipped catheter damage to the >> pulmonary artery. 
>> Ann Thorac Surg 1983; 35: pp 326-328 
>> 
>> Tomas 
>> 
>> -----Original Message----- 
>> From: openheart-l-bounces at lists.hsforum.com [mailto:openheart-l->> bounces at lists.hsforum.com] On Behalf Of Dr. Roberto Battellini 
>> Sent: Friday, November 03, 2006 12:01 PM 
>> To: OpenHeart-L at lists.hsforum.com 
>> Subject: AW: [HSF] Pulmonary Artery Catheters ! 
>> 
>> As less as possible. We had here 2 cases in the last 5 years of >> perforation 
>> of the pulmonary arteries and terrible intrapulmonary bleeding, >> they finally 
>> died. One of them was a case of mine, 80 years old, needed right 
>> pneumonectomy...game over--> for Wikipedia 
>> Roberto 
>> 
>> -----Ursprüngliche Nachricht----- 
>> Von: openheart-l-bounces at lists.hsforum.com 
>> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von >> Nasser F. 
>> Abou'Seada 
>> Gesendet: Freitag, 3. November 2006 11:30 
>> An: OpenHeart-L at lists.hsforum.com 
>> Betreff: RE: [HSF] Pulmonary Artery Catheters ! 
>> 
>> How frequently do members of the forum use PA Catheter ? 
>> - Comments ?? 
>> 
>> NFA 
>> 
>> HEART CATHETERS DO NOT BENEFIT PATIENTS 
>> 
>> (Editorial: Pulmonary artery catheters) 
>> http://bmj.com/cgi/content/full/333/7575/930 
>> 
>> 
>> 
>> Doctors should probably stop using pulmonary artery catheters >> because they 
>> do not benefit patients, say doctors from Australia in this week's >> BMJ. 
>> 
>> The pulmonary artery catheter was invented in 1968. It enabled >> bedside 
>> monitoring in critically ill patients by measuring heart output and 
>> capillary pressure in the lungs and became widely used in >> intensive care 
>> units. 
>> 
>> But reports of serious complications soon appeared and arguments >> for and 
>> against its use have continued ever since. 
>> 
>> The most recent evaluation, commissioned by the NHS Health Technology 
>> Assessment (HTA) programme, found that pulmonary artery catheters >> do not 
>> benefit patients and concluded that withdrawing them from UK >> intensive care 
>> units would be cost effective. 
>> 
>> Another recent trial in patients with acute lung injury confirmed >> these 
>> findings, while an analysis of 13 trials reported no overall >> effect of using 
>> these devices on mortality or length of hospital stay. 
>> 
>> So what should clinicians do with all this information? 
>> 
>> Given that the use of pulmonary artery catheters increases the >> risk of 
>> important complications, continued use of these devices is >> difficult to 
>> defend, say the authors. 
>> 
>> The onus is now on the proponents of the pulmonary artery catheter >> and 
>> related devices to limit their use to clinical trials and to show >> that 
>> protocols based on such devices do benefit patients, they conclude. 
>> 
>> 
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