Central venous and pulmonary artery catheters

Central venous catheters are often inserted to monitor ICU patients. Ideal positioning should place the tip between the right atrium and the last venous valve, approximately 2.5 cm from the confluence of the internal jugular and subclavian veins, between the medial portion of the first rib and the level of the carina ( Henschke etal 1996). Peripherally inserted central catheters are becoming more popular for long-term therapy but are thin and often difficult to visualize. These catheters can almost always be visualized with properly exposed and positioned bedside radiographs and only very rarely require oblique positioning or contrast injection to confirm their placement. Pulmonary artery (Swan-Ganz) catheters are also commonly placed in ICU patients. Typical positioning is in the distal main pulmonary arteries on either side, more commonly on the right (Henschke,, etal 1996). While ideal radiographic positioning is near the bifurcation of the right pulmonary artery, adequacy of placement should also be correlated with the waveforms obtained. Complications of pulmonary artery catheter placement include arrhythmias, pulmonary infarction, pulmonary artery perforation, knotting of the catheter, and sepsis. Radiographs should be obtained after pulmonary artery catheter placement, but once positioning and complications have been excluded, routine follow-up films need not be obtained ( Henschke,,etal 1996).

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