Pulmonary artery catheterization is a procedure using a long, thin tube called a catheter inserted into a pulmonary artery. It can help diagnose and manage a wide variety of health problems.
The pulmonary arteries are the two major arteries coming 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. There, the blood picks up more oxygen and releases carbon dioxide.
Pulmonary artery catheterization uses a catheter that has an inflatable balloon at its tip. The healthcare provider 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 healthcare provider then inflates the balloon and wedges it into a small pulmonary blood vessel. With the catheter in place, he or she can learn more about pressure in the right side of the heart and in the arteries of the lungs. Blood samples can also be taken at various sites within the heart to understand blood oxygen flow. The procedure can also tell other important details, such as heart output. The findings can help in treating many health conditions.
Many people in the intensive care unit will need this procedure. Healthcare providers also may do it as part of a cardiac catheterization procedure. They use it to help diagnose many health problems. These include:
- Pulmonary edema. The test helps find the cause of fluid buildup in the lungs.
- Heart failure. This test evaluated heart pressures and blood flow in a weak heart.
- Congenital heart disease. This test may help understand the flow of blood within the heart affected by a birth defect.
- High blood pressure in the lungs (pulmonary hypertension)
- Fat embolism (clot that is blocking a blood vessel)
Pulmonary artery catheterization can help guide treatment. It can also help your provide know how serious your illness is. For example, it can help with:
- Complicated heart attacks
- Being unstable before or after surgery
- High blood pressure during the latter part of pregnancy (severe preeclampsia)
- Drug therapy
- Fluid levels in the blood vessels
- Kidney failure
- Heart failure
- Ventilator management
Complications are uncommon with pulmonary artery catheterization. But it does have risks. Risk factors vary based on your overall health and any other health problems you have. Ask your healthcare provider about your specific risks. Possible risks include:
- Abnormal heart rhythms, some of which can be life threatening
- Right bundle branch block, which is often temporary
- Knotting of the catheter
- Rupture of the pulmonary artery
- Severely reduced blood flow to part of the lung
- Blood clots, which can cause a stroke
- Infection of the heart valves (endocarditis)
- Infections of the catheter
- Bleeding at the insertion site
There is also a risk of inaccurate catheter placement. If this happens, the device can give incorrect information. That can affect treatment.
Healthcare providers always weigh the benefits and risks of the procedure for specific people. Risks may be higher for some people. These include older adults and people who have higher pressure in the vessels of the lungs.
Ask your healthcare provider how to get ready for this procedure. You may need to avoid eating and drinking for 6 hours or more beforehand. You may also need to stop taking certain medicines, as directed by your healthcare provider.
Your healthcare provider may want some other tests before the procedure. These might include:
- Chest X-ray
- Electrocardiogram, to look at heart rhythm
- Blood tests, to check general health
- Echocardiogram, to see blood flow through the heart and to view the fluid around the heart
Talk with your healthcare provider about exactly what will happen. A healthcare provider and a special team of nurses will do the procedure. It will often take place at the bedside in an intensive care unit. Or it may occur in a special catheterization lab. In general:
- You will be awake. You may be given medicine to make you sleepy before the procedure starts.
- Your vital signs will be closely watched. Healthcare providers will be prepared to step in if problems happen.
- Your healthcare provider will select the blood vessel where he or she will insert the catheter. That might be in the arm, in the neck, in the groin, or below the collarbone.
- The provider injects a numbing medicine under the skin at the site where the catheter will be inserted.
- The provider uses a special needle to enter the blood vessel. He or she will put a wire into this vessel.
- The provider puts a catheter over this wire, and then removes the wire.
- The provider moves a smaller catheter with a balloon at its tip through the blood vessel. He or she will use the first tube as a guide.
- The provider moves the catheter to the right atrium. He or she then inflates the balloon at the tip. The provider will move the tube farther through the right ventricle and then out through a pulmonary artery to a smaller vessel.
- The provider may use X-ray images to carefully watch the catheter.
- Once the tube is in position, it will be fastened to the skin with tape or sutures, so it can’t move.
Ask your healthcare provider about what to expect after the procedure. In general:
- You may be groggy and disoriented.
- Your vital signs will be closely watched. These include your heart rate, blood pressure, breathing, and oxygen levels.
- You will need a chest X-ray to confirm the position of the catheter. You may need daily X-rays as long as you have the tube.
- Most people who have pulmonary artery catheterization are very ill. These people may need to stay in the hospital for at least several days.
- If the tube is needed for more than a few days, it will be removed and a new one put in a different site to help prevent infection.
- Once the catheter is no longer needed, it will be removed.
After you leave the hospital:
- Don’t do vigorous exercise until your healthcare provider says you are ready. Much of your recovery will depend on why you had the procedure.
- Make sure you keep all your follow-up visits with your healthcare provider.
- Call your healthcare provider if you have a fever, increased draining from where the needle was inserted, chest pain, or any severe symptoms.
- Follow all your healthcare provider’s instructions on medicine, exercise, diet, and wound care.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Pulmonary artery catheterization: Indications, contraindications, and complications in adults, Up To Date
Kang, Steven, MD,Fetterman, Anne, RN, BSN