Pulmonary artery catheterization. Indications and Contraindications.




Although there is limited evidence of favourable outcomes from the use of the pulmonary artery catheter, it remains an important diagnostic tool in the management of critically-ill patients,  specifically  when  knowledge  of  intracardiac  pressures and oxygenation parameters is considered to be particularly important.




 The pulmonary artery wedge pressure (PAWP) reflects left atrial pressure, and thus left ventricular end-diastolic pressure (LVEDP), assuming that continuity of the circulation is  preserved.

 Indications for pulmonary artery catheterization:

 Surgery:

  • Intra- and postoperative monitoring of high risk surgical patients.
  • Surgical procedures involving massive volume shifts.
Assess volume status:
  • Renal failure.
  • Cirrhosis.
Acute myocardial infarction:
  • Acute mitral regurgitation.
  • Hypotension.
  • Congestive heart failure.
  • Cardiac tamponade.
  • Ventricular septal defect.
  • Right ventricular infarction.
Congestive heart failure: titrate vasodilator therapy

Acute pulmonary embolism.

Respiratory failure:
  • Non-cardiogenic (acute respiratory distress syndrome).
  • Cardiogenic.


 The absolute contraindications are rare and include conditions in which catheter advancement may be interrupted or harmful. Coagulopathy should be corrected if possible. 



Absolute:


  • Right atrial or right ventricular mass (tumour or thrombus).
  • Tricuspid or pulmonary valve stenosis.
  • Mechanical tricuspid (or pulmonary) valve prosthesis.
  • Tricuspid or pulmonary valve endocarditis.
  • Tetralogy of Fallot.
Relative:

  • Coagulopathy.
  • Neutropenia.
  • Arrhythmias.
  • Left bundle branch block.
  • Recent  implantation  of  permanent  pacemaker  or 
    cardioverter–defibrillator.
  • Bioprosthetic tricuspid (or pulmonary) valve.
  • Electrolyte abnormalities.
  • Digoxin toxicity.




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