Utilizing transesophageal echocardiography for placement of pulmonary artery catheters.

Abstract

Pulmonary artery catheters (PACs) 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). Prospective observational cohort study. Large urban academic medical center. 30 males and 30 females undergoing cardiac surgery requiring cardiopulmonary bypass. 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. 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 43.6cm in females and 46.5cm in males (P=.0004). The mean wedge distance was 47.5cm in females and 51.9cm in males (P<.0001). The differences between distances of wedge and TEE positions (5.39cm, males; 3.93cm, females) were also significant (P<.0001). 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.