Management

Monitor PA pressure continuously to recognise forward catheter migration and pulmonary arterial occlusion. If so, correct immediately by partial catheter withdrawal to prevent infarction.

The risk of local infection (usually Staph. aureus or coagulase negative staphylococci) rises after 5 days. A catheter change over a guidewire may be sufficient if unexplained pyrexia or neutrophilia develops. Removal ± change of site is needed if the site is cellulitic, or positive cultures are grown from either line tip or blood.

Withdraw samples of pulmonary artery blood slowly from the distal lumen to prevent 'arterialization', i.e. pulmonary venous sampling.

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