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Utilizing transesophageal echocardiography for placement of pulmonary artery catheters
Author(s) -
Baer John,
Wyatt Matthew M.,
Kreisler Kenneth R.
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13812
Subject(s) - medicine , pulmonary artery , cardiology , left pulmonary artery , ascending aorta , centimeter , catheter , aorta , pulmonary artery catheter , surgery , cardiac output , hemodynamics
Objective Pulmonary artery catheters ( PAC s) have routinely been positioned by wedging into the pulmonary artery before pulling back 1–2 centimeters or advancing the PAC several centimeters after achieving a pulmonary artery waveform. A rare, major complication is pulmonary artery rupture. This study presents transesophageal echocardiography ( TEE ) for PAC placement by leaving the catheter tip at the one o'clock position, upper window short‐axis view of the ascending aorta at the bifurcation of the pulmonary artery ( TEE distance). Design Prospective observational cohort study. Setting Large urban academic medical center. Participants 30 males and 30 females undergoing cardiac surgery requiring cardiopulmonary bypass. Intervention TEE was utilized to obtain an upper esophageal short‐axis view of the aorta with long‐axis view of the main and right pulmonary arteries. Measurements and Results The distance between TEE position and wedge position was recorded along with patients’ gender, height, and weight. A correlation was found between TEE and wedge distances ( P < .0001). There were significant gender differences in TEE distance, with a mean of 43.6 cm in females and 46.5 cm in males ( P = .0004). The mean wedge distance was 47.5 cm in females and 51.9 cm in males ( P < .0001). The differences between distances of wedge and TEE positions (5.39 cm, males; 3.93 cm, females) were also significant ( P < .0001). Conclusions By securing the PAC at the one o'clock TEE position, physicians are assured of a safety margin of several centimeters. This direct visualization method for PAC placement may decrease the risk for accidental wedging intraoperatively.