What Are the Common Complications of Pulmonary Artery Pressure Monitoring?

Pulmonary artery pressure monitoring involves inserting a pressure sensor via catheter in the artery that carries blood between the heart and lungs. This can help diagnose heart failure, clots and other cardiovascular problems.

Pulmonary arteries are the major arteries arising from the right ventricle of the heart. This lower chamber of the heart contains blood that is low in oxygen. The pulmonary arteries carry this blood to the lungs, where the blood picks up more oxygen and releases carbon dioxide.

A pulmonary artery catheterization is a procedure of inserting a long, thin tube (catheter) into a pulmonary artery to diagnose and manage various health problems.

A pulmonary artery catheterization uses a catheter that has an inflatable balloon at its tip. The doctor puts this tube through a large vein. The tube is then moved to the right atrium, one of the heart’s upper chambers. It is then moved on through the right ventricle and out through a pulmonary artery. The doctor then inflates the balloon and wedges it into a small pulmonary blood vessel. With the catheter in place, a doctor can evaluate pressure on the right side of the heart and the arteries of the lungs. Blood samples can be obtained from various sites within the heart to gauge blood oxygen flow. Moreover, the procedure can provide other important details, such as heart output. The findings can help in treating many health conditions.

Usually, patients in the intensive care unit need this procedure. Doctors may also perform it as part of a cardiac catheterization procedure. They use it to help diagnose many health problems including:

• Shock
• Pulmonary edema: The test helps find the cause of fluid buildup in the lungs.
• Heart failure: This test evaluates heart pressure and blood flow in a weak heart.
• Congenital heart disease: This test may help map the flow of blood within the heart affected by a birth defect.
• Pulmonary hypertension (High blood pressure in the lungs)
• Fat embolism (a clot that is blocking a blood vessel)

A pulmonary artery catheterization can help in treatment of:

• Aspiration of air emboli (bubbles acting as clots)
• Complicated heart attacks
• Instability before or after the surgery
• Severe preeclampsia (high blood pressure during the latter part of pregnancy)
• Drug therapy
• Fluid levels in the blood vessels
• Burns
• Kidney failure
• Heart failure 
• Ventilator management

A pulmonary artery catheter procedure involves catheter insertion into the right side of the heart and into the arteries that lead to the lungs. It is usually inserted into the central vein (femoral, jugular, antecubital or brachial) that connect to the right side of the heart and advance toward the pulmonary artery. This is a major procedure, and the doctor may take a few hours to complete it.

• The patient’s vital signs will be monitored after administering local or general anesthesia.
• The doctor may select the blood vessel to insert the catheter that might be in the arms, neck, thigh region or below the collarbone.
• The doctor uses a special needle to enter the blood vessel and to put a wire into this vessel.
• The doctor puts a catheter over this wire and then removes the wire.
• The doctor moves a smaller catheter with a balloon at its tip through the blood vessel. 
• The doctor moves the catheter to the right atrium. He/she may then inflate the balloon at the tip. The doctor may move the tube farther through the right ventricle and then out through a pulmonary artery to a smaller vessel.
• Doctors usually use X-ray images to carefully observe the catheter.
• Once the tube is in position, it will be fastened to the skin with tape or sutures, so it cannot move.

Complications are uncommon with pulmonary artery catheterization and monitoring. However, possible risks include:

• Abnormal heart rhythms, some of which can be life threatening,
• Right bundle branch block, which is often temporary (the heart is unable to conduct electrical signals)
• Knotting of the catheter
• Rupture of the pulmonary artery
• Severely reduced blood flow to part of the lung
• Blood clots causing a stroke,
• Endocarditis (infection of the heart valves)
• Infections of the catheter
• Bleeding at the insertion site
• Inaccurate catheter placement. If this happens, the device can give incorrect information, affecting the treatment.