title: Pulmonary artery catheter knotting in a coronary artery bypass surgery patient.
abstract: A fifty seven years old female patient came to operating room for coronary artery bypass grafting (CABG) surgery. After induction, invasive monitoring lines were placed. Pulmonary artery catheter (PAC) floated after three attempts and it was wedged at 60cm. Intra operative course was smooth and patient transferred to cardiac intensive care unit (CICU). First chest X-ray revealed PAC knotting in the right ventricle. Vascular surgeon was involved and he removed it through right internal jugular vein under fluoroscopic guidance. Pulmonary arterial catheterization is an invasive procedure. Knotting usually occurs due to excessive advancement of the pulmonary artery catheter beyond the normally expected distance. The removal of a catheter should never be forced when resistance is encountered. PA catheter knotting is a rare complication but it should be suspected whenever there is excessive length of catheter required to reach pulmonary artery.
authors.affiliation: Department of Anaesthesia, The Aga Khan University, Karachi.
authors.forename: Mohammad Irfan
authors.initials: MI
authors.lastname: Akhtar
authors.forename: Mohammad
authors.initials: M
authors.lastname: Hamid
authors.forename: Fazal Hameed
authors.initials: FH
authors.lastname: Khan
authors.forename: Hamid Iqil
authors.initials: HI
authors.lastname: Naqvi
authors.forename: Amar
authors.initials: A
authors.lastname: Gangwani
mesh_terms: D002407:Catheterization, Swan-Ganz / Q000009:adverse effects* / Q000295:instrumentation; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D008875:Middle Aged; D011651:Pulmonary Artery / Q000473:pathology*