Abstract
This case report describes removal of a knotted, subclavian, pneumonic artery catheter using a tracheostomy dilator. With this simple method an encroaching procedure might be averted. Keywords:
knotting, pulmonary artery catheter, tracheostomy dilator
Reading: Percutaneous removal of a knotted pulmonary artery catheter using a tracheostomy dilator – PMC
Introduction
pneumonic artery catheterization is a well established proficiency in the management of the critically ailment. This technique is not entirely without complications, however. unplayful complications occur in only 3-4.4 % [ 1, 2 ], and include pneumothorax, hemothorax, pneumonic artery rupture, valve damage, dysrhythmias and rarely knot of the catheter. In case of a knotted catheter, its subsequent withdrawal may lead to damage of the tricuspid valve, or rupture of the papillary muscle or vessel wall [ 3 ]. In the award case, a subclavian Swan Ganz ( pneumonic artery ) catheter, after formation of a knot, became hard stuck between the clavicle and the second rib, and its subsequent method acting of removal is described .
Case report
A 69-year-old male with a history of silicosis was admitted to our hospital with a splenic abscess, for which computed tomography-guided transdermal drain was performed. subsequently, he developed septic daze and respiratory failure, necessitating mechanical ventilation. A pneumonic artery catheter was uneventfully introduced via the right subclavian vein to manage fluent resuscitation and administration of inotropic agents. initially, the patient recovered, and the Swan Ganz catheter was removed after 4 days. The abscess persisted, however, with ensuing haemodynamic instability. A splenectomy was performed, and postoperatively, in so far another uneventful operation, a new pneumonic artery catheter ( Criti Cath Thermodilution, 7F, SP 5107 H ) was inserted through the leave subclavian vein. Chest radiography showed a knot in the catheter at a distance of 16 curium from the topple, however ( Fig ) .Open in a separate window An undertake was made to remove the catheter. On aristocratic pulling the nautical mile appeared to be hard stuck between the leave clavicle and the second rib, even after careful handling of shoulder and branch. Attempts to untie the nautical mile using a guidewire or to tighten the nautical mile using traction at the introducer cocktail dress were unsuccesful. We felt reluctant to pull out the catheter with sheath without reducing the size of the knot, because of the risk of laceration of the subclavian vein. After application of a local anesthetic anesthetic and thorough antiseptic treatment of the catheter, the distal end of the catheter was cut murder and the compromising introducer sheath was removed. then a 12 F tracheostomy dilator ( Cook, Ciaglia transdermal tracheostomy introducer set, C-PTS-100 ; William Cook Europe AIS, Bjaeverskov, Denmark ) was inserted over the remaining contribution of the catheter whithout encountering any resistance. The catheter was cautiously withdrawn until the knot reached the end of the dilator. There the knot was pulled mean, but could not be retracted into the dilator. The knot had approximately the lapp circumference as the center separate of the dilator, however, and together they were removed without the happening of any further complications ( Fig ).
Open in a separate window Haemoblobin levels remained stable, and chest radiography showed no signs of hemothorax. unfortunately, the patient died 9 days subsequently because of therapy-resistant sepsis .
Discussion
Knotting of a pneumonic artery catheter is a rare complication, to which several factors may contribute. dilatation of the right ventricle ; the interpolation of a pneumonic artery catheter for more than 50 curium without achieving a pneumonic capillary chock blackmail curve ; and the presentation of an incompletely inflate balloon all entail a gamey risk of coiling and subsequent knot [ 3, 4 ]. versatile different methods for removal of knotted catheters have been reported. One approach is to pull the catheter against the introducer sheath, thereby reducing the size of the knot, followed by removing both catheter and cocktail dress [ 5 ]. In catheters inserted via the subclavian road, a potential danger is venous laceration and subsequent hemothorax.
Another method is to attempt to unwire the knot. This may be achieved by inserting a guidewire in the pneumonic artery catheter itself [ 6 ], or through the femoral vein or antecubital vein and manipulate it to untie the knot [ 7 ]. Tan et aluminum [ 8 ] achieved this by introducing a balloon catheter through the femoral vein, pushing it through the knot and inflating it, thereby unwiring it. alternatively, a Dotter basket can be inserted through the femoral vein to snare the pneumonic artery catheter and remove it in two pieces [ 9 ]. Furthermore, surgical removal can be used, either by venous cut down or open surgery ( internet explorer thoracotomy ). In the present case attempts to unwire the ravel were unsuccesfull. Because of the flexibility of the introducer sheath it was not possible to tighten the knot far without the risk of damaging the cocktail dress and thereby inducing venous tearing. We therefore removed the introducer cocktail dress and replaced it with a firm tracheostomy dilator with a diameter close to that of the knot. After that the knot could be tightened further and the catheter effortlessly removed. This procedure is similar to that used by Dach et alabama [ 10 ] with a biliary stent catheter. Although there still remains a chance of venous laceration and subsequent hemothorax, we believe this routine reduces the risk of run of the subclavian vein. The preferable proficiency to remove a ravel Swan Ganz catheter is to untie the knot, but in some cases this can not be achieved. In those cases, removal of a reduce knot resting behind an unflexible cocktail dress or tracheostomy dilator with a comparable diameter could be a simple, elegant and noninvasive solution .
I am broadly interested in how human activities influence the ability of wildlife to persist in the modified environments that we create.
Specifically, my research investigates how the configuration and composition of landscapes influence the movement and population dynamics of forest birds. Both natural and human-derived fragmenting of habitat can influence where birds settle, how they access the resources they need to survive and reproduce, and these factors in turn affect population demographics. Most recently, I have been studying the ability of individuals to move through and utilize forested areas which have been modified through timber harvest as they seek out resources for the breeding and postfledging phases. As well I am working in collaboration with Parks Canada scientists to examine in the influence of high density moose populations on forest bird communities in Gros Morne National Park. Many of my projects are conducted in collaboration or consultation with representatives of industry and government agencies, seeking to improve the management and sustainability of natural resource extraction.