Femoral vein pulmonary artery catheterization in the intensive care unit.

Abstract

OBJECTIVES: To evaluate the success and complications of pulmonary artery catheterization via the femoral vein without the use of fluoroscopy, in the medical ICU. DESIGN: We retrospectively reviewed the charts of all patients receiving pulmonary artery catheters through the femoral vein in the medical ICU between July 1, 1988 and June 30, 1992. SETTING: Medical ICU at Bronx Municipal Hospital Center. PATIENTS: Thirty-three patients were studied (20 male and 13 female). The patients ranged in age from 24 to 83 years, with the mean age of 56 years. The condition at the time of catheterization was classified as septic shock (n = 22), gastrointestinal bleed (n = 7), cardiogenic shock (n = 1), cardiac tamponade (n = 1), preoperative (n = 1), or drug overdose (n = 1). MEASUREMENTS: In each case, pulmonary artery pressure tracings, electrocardiographic recordings, procedure, and nursing notes were reviewed from the time of catheter insertion. Charts were also analyzed for evidence of catheter-related septicemia, deep vein thrombosis, pulmonary embolism, or problems developing at the insertion site. RESULTS: Femoral vein pulmonary artery catheterization was performed successfully in 37 of 39 attempts (95 percent success rate) without the use of fluoroscopy. Five of the 33 patients studied had more than one femoral vein pulmonary artery catheter during their hospital course. Four of them had two femoral vein pulmonary artery catheters and the fifth patient had three femoral vein pulmonary artery catheters. Overall, 39 attempts at femoral vein pulmonary artery catheterization were made in the 33 patients studied. Three patients had 10- to 19-beat ventricular tachycardia (7.7 percent incidence) precluding catheter insertion via this approach in two instances. There was no clinical evidence of major hematomas or hemorrhages, catheter-related septicemia, deep vein thrombosis, or pulmonary emboli in any of our patients. CONCLUSION: Femoral vein pulmonary artery catheterization without the use of fluoroscopy is safe and effective.