Korean J Anesthesiol.  2003 Jul;45(1):167-171. 10.4097/kjae.2003.45.1.167.

Early Recognition of Air Leakage from the Balloon of Pulmonary Artery Catheter during Its Advancement by Transesophageal Echocardiography

• Kim TY
• Park SJ
• Lee SH
• Kim IK
• Shin MK

• KMID: 2236754
• DOI: http://doi.org/10.4097/kjae.2003.45.1.167

Abstract

Transesophageal echocardiography (TEE) in addition to the conventional pressure tracing method may enhance a proper insertion of pulmonary artery (PA) catheter by providing information about the real-time location of catheter. We report a case of abrupt air leakage from the balloon of PA catheter during its advancement that was immediately diagnosed by TEE in 54-year-old male with moderate tricuspid regurgitation for elective CABG. Introducer and sheath of PA catheter were inserted in right internal jugular vein. After checking balloon function, connecting distal port to a previously zeroed transducer and confirming the location in right atrium, PA catheter was advanced under direct the visual surveillance by TEE images as well as pressure tracing. During the third trial of catheter advancement through tricuspid valve, multiple air shadows, which convincing balloon leakage, were appeared in right atrium in the view of TEE after inflation of air. We withdrew catheter immediately without any further effort of balloon inflation or advancement, then, balloon leakage and the incapability of balloon expansion were confirmed by saline injection, instead of air, into the balloon port. We replaced the injured PA catheter to new one, and advanced it successfully to the wedged position by the aid of TEE and pressure tracing. We assumed that TEE image might be a beneficial aid to enhancing PA catheter placement in a proper position and preventing possible complications or side effects produced by advancing it with unawareness or delayed recognition of its dysfunction.

Keyword

monitoring; pulmonary artery catheter; transesophageal echocardography

MeSH Terms

Catheters*
Echocardiography, Transesophageal*
Heart Atria
Humans
Inflation, Economic
Jugular Veins
Male
Middle Aged
Pulmonary Artery*
Transducers
Tricuspid Valve
Tricuspid Valve Insufficiency