Pulmonary artery catheterization (PAC) is a common procedure during which patients get an intravascular catheter inserted through a central vein to the right ventricle and into a pulmonary artery to diagnose multiple health problems. This diagnostic tool helps learn the heart’s and lungs’ conditions and choose the most appropriate treatment method (Shaw et al., 2018). However, as well as any medical procedure, PAC may be characterized by certain risks. Therefore, patients have to be properly informed about the details of the process, and nurses must know how to manage complications. In this paper, attention will be paid to such PAC complications as infection, air embolism, and thrombosis, their symptoms, and management to decrease morbidity and mortality related to the condition.
Infection is one of the possible long-term PAC complications that may occur either within the catheter or around the catheter’s placement site. Its diagnosis may be categorized as “exist site, tunnel, or catheter-related bacteremia” (Bream, 2016). According to Yetmar et al. (2019), central-line-associated bloodstream infections are diagnosed in 10% of patients. The signs of PAC-related infections are redness around the central line site, fever (more than 100.4 degrees), chills, and smell. To predict this type of infection, nurses have to remove a catheter carefully, following the standards of hand hygiene and dressing (sterile scissors and gloves). It is also recommended to prescribe antibiotics and reduce infection risks in patients.
There are several major complications that may occur immediately after the catheter placement, and air embolism is one of them. In the majority of cases, nurses and doctors use valved peel-away sheaths, follow fluoroscopic guidance, and thoroughly analyze radiographic images to decrease the risk of air embolism (Bream, 2016). The diagnosis of air embolism is approved when air entrainment from the infusion port is identified. Its main threat is that this condition can be asymptomatic for a certain period of time. When it gains a severe form, such signs as difficulty breathing, low blood pressure, and muscle pain are observed. To manage air embolism, patients are treated with 10 L of oxygen through a mask (Bream, 2016). If this intervention does not help, the patient should be placed on their left side, and a vigorous suction is applied to move the air.
Catheter malfunction may also be caused by thrombosis that is usually related to fibrin sheaths. It is diagnosed when the inability to aspirate a catheter is observed. Swelling, pain, and change in color are the primary symptoms of this condition. Thromboses may be of different sizes, with small thrombus being able to flush on their own, and large thrombus causing hemodynamic changes. The primary preventive intervention is to use anticoagulation, and the secondary step is to remove the catheter (Bream, 2016). The tertiary nursing intervention to manage PAC-related thrombus is to aspirate the clot and use thrombolytic agents for dissolution.
In general, PAC procedures are used to examine patients and help them improve their health and predict complications. However, the risks of catheter usage cannot be ignored, and nurses must understand that their observations and care are vital for patients. The list of complications associated with PAC, including infections, thrombosis, and air embolism, is not full, and more short- and long-term risks have to be detected. Regarding current technological and organizational improvements in health and nursing care, many conditions and increased mortality and morbidity rates may be prevented and controlled.
Bream, P. (2016). Update on insertion and complications of central venous catheters for hemodialysis. Seminars in Interventional Radiology, 33(1), 31–38. Web.
Shaw, A. D., Mythen, M. G., Shook, D., Hayashida, D. K., Zhang, X., Skaar, J. R., Iyengar, S. S., & Munson, S. H. (2018). Pulmonary artery catheter use in adult patients undergoing cardiac surgery: A retrospective, cohort study. Perioperative Medicine, 7(1). Web.
Yetmar, Z. A., Lahr, B., O’Horo, J., Behfar, A., Sampathkumar, P., & Beam, E. (2019). Pulmonary artery catheter epidemiology of risk in pre–heart-transplant recipients. Infection Control & Hospital Epidemiology, 40, 632-638. Web.