Multiple attempts during pulmonary artery catheter insertion should raise suspicion of the tip slipping back into the right ventricle, potentially causing perforation.
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Alerts to RV perforation risk with difficult PAC placement in CABG; hypothesis-generating for preventive strategies.
A 70 years old male underwent Coronary Artery Bypass and Graft (CABG) surgery. After induction, a Pulmonary Artery Catheter (PAC) was inserted via right IJV with some difficulty in achieving PA tracing. During distal RCA anastomosis, surgeon noticed PAC tip coming out of Right Ventricular (RV) surface. Resistance was felt on trying to pull PAC, so it was left there. Cardiac surgeon then opened the Right Atrium (RA) and pulled out the catheter. Multiple attempts during insertion of PA catheter should always raise the suspicion of PAC tip slipping back into the RV. It should be closely monitored during surgery and communicated to the surgeon.
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Ahsan et al. (2014) studied this question.
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