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Egbuche O, Nwagbara K, Mezue KN, Abe T, Nwokike S. Transvenous Retrieval of a Pulmonary Artery Catheter Knot Around Pacing Leads: A Case Report. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 28S:144-146. [PMID: 33077395 DOI: 10.1016/j.carrev.2020.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/08/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Pulmonary Artery Catheter (PAC) knotting is a rare complication of PAC insertion. In patients with dilated right heart chambers, blind insertion of PAC significantly increases the risk of catheter knotting. We demonstrate a safe and successful approach to resolving a PAC knot around pacing leads of a cardiac resynchronization device. CASE PRESENTATION A 63-year-old African American male with dilated cardiomyopathy and a cardiac resynchronization therapy (CRT) device for severe left ventricular systolic dysfunction required PAC insertion for hemodynamic management of acute heart failure. PAC insertion was complicated by catheter knotting around the pacing leads. The PAC was successfully retrieved using a transvenous technique. CONCLUSION Fluoroscopy-guided insertion of PAC is advisable and preferred over blind insertion in patients with high risk of PAC entanglement. LEARNING OBJECTIVE To highlight a potential complication of blind pulmonary artery catheter insertion and provide a safe technique to resolve catheter knots.
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Affiliation(s)
- Obiora Egbuche
- Division of Cardiovascular Disease, Morehouse School of Medicine, Atlanta, GA, United States of America.
| | - Kenechukwu Nwagbara
- Division of Hospital Medicine, Mercy Hospital, Joplin, MO, United States of America
| | - Kenechukwu N Mezue
- Division of Nuclear Cardiology, Massachusetts General Hospital, Boston, MA, United States of America
| | - Temidayo Abe
- Department of Internal Medicine, Morehouse School of Medicine, Atlanta, GA, United States of America
| | - Shirley Nwokike
- Department of Medicine, Medical College of Georgia, Augusta, GA, United States of America
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Perez d'Empaire P, Derzi S, Latter D, Tousignant C. Pulmonary Artery Catheter Knotted in the Tricuspid Valve Apparatus Requiring Surgery With Cardiopulmonary Bypass: A Case Report. A A Pract 2019; 13:181-184. [PMID: 31162226 DOI: 10.1213/xaa.0000000000001028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. We present a patient with a PAC knot after aortic valve replacement. Interventional radiology (IR) determined that the catheter may have lodged in the tricuspid valve. Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.
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Affiliation(s)
- Pablo Perez d'Empaire
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre, Department of Anesthesia, University of Toronto, Canada
| | - Simone Derzi
- Department of Anesthesia, St Michael's Hospital, Department of Anesthesia, University of Toronto, Toronto, Canada
| | - David Latter
- Division of Cardiac Surgery, St Michael's Hospital, Department of Surgery, University of Toronto, Toronto, Canada
| | - Claude Tousignant
- Department of Anesthesia, St Michael's Hospital, Department of Anesthesia, University of Toronto, Toronto, Canada
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Wiens EJ, Seifer CM, Khoo C. Inadvertent Removal of a Right Ventricular Pacemaker Lead by a Knotted Transvenous Pacing Wire. Indian J Crit Care Med 2019; 23:102-103. [PMID: 31086456 PMCID: PMC6487609 DOI: 10.5005/jp-journals-10071-23126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report an unusual complication of permanent pacemaker (PPM) implantation in a patient with a temporary transvenous pacemaker (TVP) in situ, in which the TVP lead formed a knot around the newly-placed right ventricular (RV) lead, complicating TVP removal. The case underscores the fact that suboptimal TVP lead placement, such as looping in the RV, can result in complications during implantation of a permanent pacemaker.
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Affiliation(s)
- Evan J Wiens
- Department of Internal Medicine, Max Ready College of Medicine, University of Manitoba, Winnipeg MB, Canada
| | - Colette M Seifer
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Clarence Khoo
- Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada
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Nawale JM, Patil SN, Nalawade DD, Borikar NA, Sonawane BS, Chaurasia AS. Successful percutaneous retrieval of unusually knotted temporary pacemaker lead. Indian Pacing Electrophysiol J 2018; 18:148-149. [PMID: 29477309 PMCID: PMC6090000 DOI: 10.1016/j.ipej.2018.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 11/25/2022] Open
Abstract
Implantation of temporary pacemaker lead is commonly performed procedure and is usually safe, but can sometimes develop rare and serious complication like intracardiac lead knotting which may require challenging retrieval techniques. We report a case of successful percutaneous retrieval of unusually knotted right internal jugular venous temporary pacing lead via left femoral transvenous approach using snare over a long sheath after cutting the electrode proximally and thus avoiding any surgical intervention.
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Hong B, Park H, Yoon Y, Jung C, Kim YH, Lim CS. Interventional Removal of Knotted Pulmonary Artery Catheter: A Case Report. J Intensive Care Med 2017; 33:322-324. [PMID: 28946777 DOI: 10.1177/0885066617733933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 60-year-old female patient underwent emergency cadaveric liver transplantation. During the insertion of the pulmonary artery catheter (PAC) through the left innominate vein, advancement of the catheter was not successful and a knot occurred. An interventional radiologist performed antegrade rigid wire insertion into the PAC and succeeded in loosening the knot in the vessel. We report the successful removal of a knot through intervention without additional invasive procedures in a hemodynamically unstable patient with a coagulopathy.
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Affiliation(s)
- Boohwi Hong
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
| | - Hyunwoo Park
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
| | - Yeomyung Yoon
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
| | - Choonho Jung
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
| | - Yoon Hee Kim
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
| | - Chae Seong Lim
- 1 Department of Anesthesiology and Pain Medicine, Chungnam National University College of Medicine, Jung-gu, Daejeon, Korea
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Mohandes M, Rodríguez N, Fernández F, Moreno C, Palazón O, Bardají A. Percutaneous Retrieval of a Knotted Provisional Pacemaker Using Proximal Electrode Cut off and Distal End Snaring. Heart Views 2017; 18:50-53. [PMID: 28706596 PMCID: PMC5501029 DOI: 10.4103/1995-705x.208672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Although provisional pacemaker implantation can safely be done in many cases, a rare complication such as knotted electrode has been described, especially when the procedure is performed without fluoroscopy guidance. We describe a case of knot creation in a provisional pacemaker which was successfully retrieved using a snare after cutting the electrode proximally.
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Affiliation(s)
- Mohsen Mohandes
- Department of Interventional Cardiology, Division of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
| | - Natalia Rodríguez
- Vascular and Endovascular Surgery, Joan XXIII University Hospital, Tarragona, Spain
| | - Francisco Fernández
- Department of Interventional Cardiology, Division of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
| | - Cristina Moreno
- Department of Interventional Cardiology, Division of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
| | - Oscar Palazón
- Department of Cardiology, San joan de Reus University Hospital, Reus, Spain
| | - Alfredo Bardají
- Division of Cardiology, Joan XXIII University Hospital, Tarragona, Spain
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Epping K, Hammer B. Removal of a pulmonary artery catheter in the presence of implanted leads. Crit Care Nurse 2012; 32:69-71. [PMID: 22855081 DOI: 10.4037/ccn2012339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Viteri G, Larrache J, Díaz ML, Alcalde JM, Lopez-Olaondo L, Bilbao JI. Nasogastric Tube Found in the Right Atrium. J Vasc Interv Radiol 2012; 23:721-2. [DOI: 10.1016/j.jvir.2012.01.067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 01/17/2012] [Accepted: 01/17/2012] [Indexed: 10/28/2022] Open
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Evans DC, Doraiswamy VA, Prosciak MP, Silviera M, Seamon MJ, Funes VR, Cipolla J, Wang CF, Kavuturu S, Torigian DA, Cook CH, Lindsey DE, Steinberg SM, Stawicki SP. Complications Associated with Pulmonary Artery Catheters: A Comprehensive Clinical Review. Scand J Surg 2009; 98:199-208. [DOI: 10.1177/145749690909800402] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Care for the critically ill patient requires maintenance of adequate tissue perfusion/oxygenation. Continuous hemodynamic monitoring is frequently utilized to achieve these objectives. Pulmonary artery catheters (PAC) allow measurement of hemodynamic variables that cannot be measured reliably or continuously by less invasive means. Inherent to every medical intervention are risks associated with that intervention. This review categorizes complications associated with the PAC into four broad groups — Complications of central venous access; complications related to PAC insertion and manipulation; complications associated with short- or long-term presence of the PAC in the cardiovascular system; and errors resulting from incorrect interpretation/use of PAC-derived data. We will discuss each of these four broad categories, followed by in-depth descriptions of the most common and most serious individual complications.
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Affiliation(s)
- D. C. Evans
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - V. A. Doraiswamy
- Department of Medicine, University of Arizona College of Medicine, Tucson, (AZ), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - M. P. Prosciak
- The Johns Hopkins Burn Center, Baltimore (MD), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - M. Silviera
- Department of Surgery, Section of Trauma/Critical Care, Temple University School of Medicine, Philadelphia (PA), U.S.A
| | - M. J. Seamon
- Department of Surgery, Section of Trauma/Critical Care, Temple University School of Medicine, Philadelphia (PA), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - V. Rodriguez Funes
- Research Unit, Hospital Nacional Rosales, El Salvador
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - J. Cipolla
- Regional Level I Trauma Center, St Luke's Hospital and Health Network, Bethlehem (PA) U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - C. F. Wang
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - S. Kavuturu
- Department of Surgery, Bronx Lebanon Medical Center, Bronx (NY), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - D. A. Torigian
- Department of Radiology, University of Pennsylvania Medical Center, Pennsylvania (PA), U.S.A
| | - C. H. Cook
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
| | - D. E. Lindsey
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - S. M. Steinberg
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
| | - S. P. Stawicki
- Department of Surgery, Division of Critical Care, Trauma, and Burn, The Ohio State University Medical Center, Columbus (OH), U.S.A
- OPUS 12 Foundation, Inc., Columbus (OH), U.S.A
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Amoretti N, Hauger O, Marcy PY, Hovorka I, Lesbats-Jacquot V, Fonquerne ME, Maratos Y, Boileau P. Foreign body extraction from soft tissue by using CT and fluoroscopic guidance: a new technique. Eur Radiol 2009; 20:190-2. [DOI: 10.1007/s00330-009-1499-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 05/10/2009] [Accepted: 05/22/2009] [Indexed: 11/24/2022]
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12
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Mahnken AH, Urban U, Fassbender H, Schnakenberg U, Schoth F, Schmitz-Rode T. Telemetric Catheter-Based Pressure Sensor for Hemodynamic Monitoring: Experimental Experience. Cardiovasc Intervent Radiol 2009; 32:714-9. [DOI: 10.1007/s00270-009-9556-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 02/26/2009] [Accepted: 03/09/2009] [Indexed: 10/20/2022]
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Atrapamiento intravascular de un catéter de Swan-Ganz. ANGIOLOGIA 2009. [DOI: 10.1016/s0003-3170(09)15012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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