Introduction:
The pulmonary artery catheter (PAC) is an excellent real-time hemodynamic monitor that is particularly useful in patients that require careful titration of potent vasoactive or inotropic medications. PAC’s are commonly used in patients with severe cardiogenic shock and during the perioperative period for cardiac surgery patients. Importantly, placement and maintenance of PAC’s are associated with complications, including arrhythmias, vascular perforation, air embolus, and catheter-induced thrombosis.
Case Description:
In our experience, PAC-induced thrombosis is quite rare. However, we recently noticed a sudden rise in thrombotic events after PA catheter placement for cardiac surgery when we switched from a heparin coated PAC to one without heparin coating. Here we present five cases in which thrombosis occurred after placement of a PAC but prior incision for cardiac surgery. In one case, the thrombus was left in situ. In three cases, the thromboses resolved upon heparin administration prior to initiating cardiopulmonary bypass (CPB). In the final case, the surgical plan for CABG off bypass was altered due to right atrial thrombus formation in the presence of a patent foramen ovale (PFO). Because of increased risk of embolic stroke, it was decided to go on CPB to repair the PFO and evacuate the thrombus.
Discussion:
PAC-induced thrombosis has important implications for surgical planning. PAC-induced thromboses have been reported with both heparin coated and non-heparin coated PAC’s. Only a few studies support the use of heparin coated catheters for prevention of PAC-induced thrombosis, and none is sufficiently powered to conclusively demonstrate a risk reduction. However, based on these five cases we strongly recommend increased vigilance for this serious complication when using PAC’s without heparin coating.
