Prevention of infection

Insertion of a pulmonary artery catheter should be performed with meticulous sterile techniques in order to prevent infection. Proper disinfection of pressure transducers is essential in preventing sepsis which may enhance the risk of catheter colonization and infection. As a guideline, pulmonary artery catheters should be removed or, if necessary, replaced after 72 h to prevent catheter sepsis, since prolonged use increases the chance of the development of sepsis, endocardial lesions, and right-sided endocarditis. Replacement over a guidewire increases the risk of bacteremia, but new punctures increase the risk of mechanical complications. Chapter References

Groeneveld, A.B.J. and Thijs, L.G. (1991). Hemodynamic monitoring in septic shock. In Strategy in hemodynamic monitoring (ed. J.-F. Dhainaut and D. Payen), pp. 179-96. Springer Verlag, Berlin.

Haller, M., Zöllner, C., Briegel, J., and Forst, H. (1995). Evaluation of a new continuous thermodilution cardiac output monitor in critically ill patients: a prospective criterion standard study. Critical Care Medicine, 23, 860-6.

O'Quinn, R. and Marini, J.J. (1983). Pulmonary artery occlusion pressure: clinical physiology, measurement and interpretation. American Review of Respiratory Disease, 128, 319-26.

Renner, L.A., Morton, M.J., and Sakuma, G.Y. (1993). Indicator amount, temperature, and intrinsic cardiac output affect thermodilution cardiac output accuracy and reproducibility. Critical Care Medicine, 21, 586-97

Smiseth, O.A., Thompson, C.R., Ling, H., Robinson, M., and Miyagishima, R.T. (1996). A potential clinical method for calculating transmural left ventricular filling pressure during positive end-expiratory pressure ventilation: an intraoperative study in humans. Journal of the American College of Cardiology, 27, 155-61.

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