Acute and Critical Care

Knotting of Pulmonary Artery Catheter During Tricuspid Valve Surgery: A Case Report: Kyung Chen Lee, Wol Seon Jung, Yong Beom Kim, Ji Yeon Lee; Korean J Crit Care Med. 2012;27(1):45-48.; DOI: https://doi.org/10.4266/kjccm.2012.27.1.45

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The use of pulmonary artery catheter can be helpful in managing patients after cardiac surgery. Nevertheless, there is a risk of serious complications, such as knotting. A 61 year old man underwent tricuspid valve replacement under cardiopulmonary bypass (CPB). After implantation of a stented tissue valve in the tricuspid valve, repositioning of the catheter was performed. After weaning from CPB, an abnormal pattern of pulmonary artery pressure was suddenly observed on the monitor. Resistance was met when removing the catheter with the balloon deflated, at a 20 cm distance from the tip of the catheter. Chest radiography showed a knot in the catheter within the right brachiocephalic vein. Superior vena cava opened and the distal part of the catheter with the knot was successfully removed.

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Chao Feng, Jipeng Fei, Kechun Wen, Weiqiang Lv, Zuoxiang Zhang, Minda Zou, Fei Yang, Muhammad Waqas, Weidong He
Solid State Ionics.2017; 303: 167. CrossRef

Detection of Pulmonary Artery Catheter Knotting by Transesophageal Echocardiography: A Case Report: Eun Soo Kim, Seung Hoon Baek, Kyu Youn Jung, Jae En Kim; Korean J Crit Care Med. 2011;26(2):98-100.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.98

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Abstract PDF

Placement of a pulmonary artery catheter is associated with various complications, including catheter knotting. Fluoroscopy can be used to visualize and confirm catheter knotting. Transesophageal echocardiography is readily available to detect knot formation in the operating room or intensive care unit. We present a case in which pulmonary artery catheter knotting was detected by transesophageal echocardiography. This method may be useful in the operating room or in the intensive care unit to identify the presence and location of catheter knotting.

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Knotting of Pulmonary Artery Catheter During Tricuspid Valve Surgery - A Case Report -
Kyung Chen Lee, Wol Seon Jung, Yong Beom Kim, Ji Yeon Lee
Korean Journal of Critical Care Medicine.2012; 27(1): 45. CrossRef

Suturing of a Pulmonary Artery Catheter during Open Heart Surgery: Kyoo Sub Chung, Seong Wan Baik, Jae Young Kwon, Jae Woo Kim, Jin Ho Song; Korean J Crit Care Med. 1998;13(1):109-112.

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Abstract PDF: Insertion of a pulmonary artery catheter for the measurement of pulmonary artery pressures and cardiac output has been widely used for the management of patients undergoing open heart surgery. Complications of pulmonary artery catheter insertion include cardiac arrhythmia, thromboembolism, tricuspid valve injury, intracardiac knotting, pulmonary artery rupture. We experienced a case of catheter-related complication which was caused by suturing pulmonary artery catheter during right atrial bleeding control during open heart surgery. The catheter was attached to the right atrial wall by nylon suture and successfully removed by operation without significant complication.

Intracardiac Knotting of a Balloon-tipped, Flow-directed Pulmonary Artery Catheter: A Case Report: Bong Chul Choi, Mee Young Chung, Chang Jae Kim, Jun Seuk Chea, Byung Ho Lee; Korean J Crit Care Med. 2005;20(2):178-182.

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Abstract PDF: The occurrence of knots and loops is a potential hazard of a balloon-tipped, flow-directed pulmonary artery (PA) catheter placement if excessive catheter length is passed into the right atrium or ventricle. Knotting of a balloon-tipped, flow-directed PA catheter leading to difficulty in its removal is a rare but serious complication. A case of knotted catheter in right atrium in a patient undergoing aortic valve replacement is presented. By passing a spring guidewire into PA catheter, we have untied the loose knotted catheter under simple fluoroscopic guidance in the intensive care unit.

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