Flow-directed Balloon Catheter Research Articles

Knotting of Intracardiac Flow-Directed Balloon Catheter: A Non-surgical Technique for Removal

Knotting of Intracardiac Flow-Directed Balloon Catheter: A Non-surgical Technique for Removal

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

A knot occurred in a flow-directed balloon tipped (Swan-Ganz) catheter inserted through the right internal jugulary vein. Knot was undone using right Judkins catheter introduced via left jugulary vein approach. By passing through the loop of knot, right Judkins catheter was used to stabilize the knotted segment and knot was unknotted by gently pulling the Swan-Ganz Catheter.

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

Knotting of intracardiac flow-directed balloon catheter: A non-surgical technique for removal

Thoracoscopic Lobectomy With Endoarterial Vascular Control: An Experimental Study in Swine

Background. Video-assisted lobectomy lacks vascular control and presents the potential for serious hemorrhage in a closed cavity. The use of a lighted, flow-directed balloon catheter in the pulmonary artery as an endovascular control device was evaluated. Methods. A modified light-bearing Swan-Ganz catheter was placed in the left or right pulmonary artery using fluoroscopy. The lit catheter was identified easily through the arterial wall at thoracoscopy. Its inflation allowed the control of proximal blood flow as required. Fully thoracoscopic lobectomy was carried out by isolating and dividing the lobar branches of the pulmonary artery, the pulmonary vein, and the bronchus in anesthetized swine. Results. Forty-two video-assisted anatomic lobectomies were completed in 30 pigs with balloon catheter control of the pulmonary artery. The balloon effectively controlled experimental hemorrhage caused by puncturing arterial branches ( n = 4). It allowed the transection of unlooped lobar arteries ( n = 42) and the main interlobar pulmonary artery ( n = 3). Catheter displacement back to the heart occurred in 5 animals and balloon catheter technical failures occurred in 3. Conclusions. The lighted, flow-directed balloon catheter was an effective means of avoiding acute hemorrhage and achieving vascular control in a swine lobectomy model.

Intra-arterial digital subtraction angiography of the pulmonary arteries using a flow-directed balloon catheter in the diagnosis of pulmonary embolism.

Selective intra-arterial digital subtraction angiography (IA-DSA) of the pulmonary vessels was performed in 70 patients suspected of acute pulmonary embolism. A flow-directed Swan-Ganz pulmonary angiography catheter was used. The spatial resolution of the equipment used was 3.3 lp/mm for DSA and 6.0 lp/mm for conventional pulmonary angiography (CPA). Image quality of the angiograms was assessed by determining the highest visible branching division of the main pulmonary artery. The mean visible branching division for IA-DSA was 4.71 (range 3-7). In 10 patients where IA-DSA and CPA were performed during the same procedure there was no difference in visualization of peripheral arteries (mean 4.70 visible order for both modalities). IA-DSA makes the procedure rapid, saves on films and contrast material and allows good visualization of areas where exposure is difficult. The spatial resolution of state-of-the-art equipment permits sufficient definition of subsegmental vessels. The use of the flow-directed balloon catheter makes the examination easy to perform and minimizes the risk of catheter induced cardiac arrhythmias.

Continuous mixed venous oxygen saturation monitoring during general anesthesia.

Clinical evaluation of continuous SvO2 monitoring during general anesthesia was made in 21 surgical patients utilizing a fiberoptic reflectometry system combined with a pulmonary artery flow-directed balloon catheter. On-line in vivo values for SvO2 by the system were closely related to those obtained in vitro from a Radiometer ABL-300. There was a good correlation between changes of in vivo SvO2 and corresponding changes in cardiac index. We also observed that there were significant correlations between SvO2 and oxygen extraction ratio, and SvO2 and oxygen delivery. These data indicate that continuous monitoring of SvO2 during general anesthesia can provide on-line information not only about hemodynamic state but also on oxygen transport, which will be especially helpful in managing hemodynamically unstable patients during anesthesia.

Clinical evaluation of continuous venous oxygen saturation monitoring during anesthesia.

Clinical evaluation of continuous SvO2 monitoring during anesthesia was made in 14 surgical patients utilizing a fiberoptic reflectometry system combined with a pulmonary artery flow-directed balloon catheter. On-line values for SvO2 by the system were closely related to those obtained in vitro from a Radiometer ABL-300. There was a good correlation between changes of in vivo SvO2 and corresponding changes in cardiac index. We also observed that there was a significant correlation between SvO2 and oxygen extraction ratio. Our data indicate that continuous SvO2 monitoring during anesthesia can provide on-line information not only about hemodynamic state but also on oxygen transport.

Distal splenic artery embolization with a flow-directed balloon catheter.

We describe the improved ability to catheterize the distal splenic artery consistently using a flexible, flow-directed, 5-F, Swan-Ganz catheter so as to embolize the spleen beyond any pancreatic branch origins to achieve the safe treatment of hypersplenism.

A new nonsurgical technique for untying tight knots in flow-directed balloon catheters

A new nonsurgical technique for untying tight knots in flow-directed balloon catheters

Knotting of Intracardiac Flow-Directed Balloon Catheter: Simple Surgical Method of Removal

A complete knot occurred in a 7F flow-directed balloon catheter inserted through the right internal jugular vein. The patient was intubated and placed under positive pressure ventilation. After gaining surgical exposure of the venipuncture site, a purse-string of Prolene 4--0 suture was placed around it. The patient was placed in the Trendelenburg position and the knotted catheter withdrawn, while the purse-string suture was immediately tightened avoiding uncontrollable hemorrhage or massive air embolism.

Experimental transcatheter splenectomy using absolute ethanol.

Since ethanol is known to be effective for transcatheter infarction of the kidney, the authors evaluated it as an agent for splenic ablation in swine and dogs. Infarction was successful in 7 of 9 pigs and 4 of 5 dogs. Controlled segmental infarction using flow-directed balloon catheters was attempted and was successful in 3 pigs and 2 dogs. The maximum blood ethanol level was 78 mg/100 ml, and by 15 minutes after injection it was less than or equal to 20 mg/100 ml. There was no evidence of pancreatic or hepatic injury at autopsy. The authors conclude that with careful catheter positioning, controlled total or partial infarction of the spleen can be safely performed with absolute ethanol without risk of abscess formation, pneumonia, or significant damage to other organs.

Pulmonary hemorrhage associated with balloon flotation catheters Report of a case and review of the literature

The development of the flow-directed balloon catheter has greatly facilitated the monitoring of seriously ill patients. As the use of this catheter has increased, so have the reports of complications, the most serious of which is fatal pulmonary hemorrhage. Eleven cases of pulmonary hemorrhage have been described in the literature, and we have reported an additional case. The presenting symptom in 10 patients was hemoptysis, and the course of eight of these patients was rapidly fatal. The most frequent significant finding at autopsy was a laceration of a small peripheral pulmonary artery, usually at a bifurcation. The pathogenesis, prophylaxis, and management of this complication are discussed.

Occlusion arteriography: diagnostic and therapeutic applicability of balloon catheters.

Occlusion arteriography using flow-directed Swan-Ganz balloon catheters is a safe and simple method, which opens up new technical, diagnostic, and therapeutic possibilities. Since 1976, occlusion arteriography with double-lumen Swan-Ganz balloon catheters and a percutaneous introducer system has been performed in 315 patients. The following advantages were found: (1) simplification of selective and subselective catheterization due to the flow-directed positioning of the balloon-tipped catheter; (2) high contrast of the arterial phase of the angiogram and demonstration of the smallest arteries as a result of a brief, complete occlusion of the main vessels ("standstill arteriogram"); (3) early and optimal demonstration of the corresponding venous system, especially optimization of the indirect splenoportogram and mesentericoportogram; (4) reduction of the volume of contrast agent usually needed for diagnostic reasons; (5) reliable and complete blockade of the tumor-feeding artery during transcatheter embolization with particulate substances; (6) reliable and complete blockade of the feeding artery as a preoperative protective measure in tumor nephrectomy and splenectomy.

Intracardiac Knotting of a Flow-Directed Balloon- Tipped Catheter

The use of pulmonary artery flow-directed balloon catheters in surgical patients has increased in recent years.1 Numerous articles2--5 have documented various complications associated with their insertion and use. The most frequent nonpulmonary complication is the occurrence of cardiac arrhythmias during the catheter insertion.6 A less frequent but potentially more severe complication is that of internal cardiac knotting.2 The Following report illustrates a case of intracardiac knotting and the possible reasons for its occurrence.

A Technique for Unknotting an Intracardiac Flow-Directed Balloon Catheter

Described is an unusual complication occurring during right-sided cardiac catheterization using a 7F flow-directed balloon catheter. During an attempt to direct the catheter from the main pulmonary artery into the pulmonary wedge position, the tip became entangled in a loop of catheter and knotted. Initially, all attempts to unknot or remove the catheter failed. A movable core guide wire was passed through the major lumen of the catheter, resulting in the immediate unknotting of the catheter, thus allowing its withdrawal.

Pulmonary artery monitoring in critically III surgical patients

Pulmonary artery catheterization with a flow-directed balloon catheter has practical application in the management of critically ill surgical patients. Reliable information regarding left ventricular function, pulmonary venocapillary hydrostatic pressure, pulmonary vascular resistance, and peripheral oxygen utilization can be derived. The underlying physiologic principles of pulmonary artery monitoring are emphasized.

PULMONARY ARTERY CATHETERIZATION AND WEDGE PRESSURE MEASUREMENT IN THE GENERAL INTENSIVE THERAPY UNIT

Central venous pressure measurement may be misleading in selective left heart failure and in patients with high pulmonary vascular resistance. More direct information about pulmonary venous pressure and left heart filling pressures may be obtained by catheterization of the pulmonary artery with flow-directed balloon catheters. The use of such catheters, without radiographic control, by those inexperienced in orthodox cardiac catheterization is αdescribed. The catheter may be used also in the measurement of cardiac output and in the treatment of a massive pulmonary embolism.

Hemodynamic Effects of Postural Changes in Patients with Acute Myocardial Infarction

In order to evaluate optimum patient position following acute myocardial infarction, hemodynamics were studied in 21 patients in the supine and semierect posture (70 degree head and thorax elevation with legs horizontal). None of the patients was in acute pulmonary edema or cardiogenic shock. Cardiac output (thermodilution technique) and right-sided pressure measurements were obtained with a triple lumen flow-directed balloon catheter. Following a change from the supine to semierect posture, right atrial pressure rose from an average of 6 to 9 mm Hg (p