PULMONARY-ARTERY CATHETERS - ARE LETHAL C OMPLICATIONS AVOIDABLE

Three cases are presented dealing with rare lethal complications durin g the insertion of pulmonary artery catheters (PAC). Complications res ulting from catheter insertion have been reported on numerous occasion s; we report further examples of inadequate insertion techniques. Case reports. Deviating from the recommended guidelines was presumably a s ignificant factor in the development of fatal pulmonary bleeding. In t he first case PAC-related perforation of the right ventricle resulting in cardiac tamponade was found at autopsy. Clinically, this perforati on had not been noticed. A guidewire was allegedly employed during ins ertion. The diameter of the perforation (3 mm) suggests that either th e balloon was deflated or the guidewire was used incautiously. In the second case during insertion the balloon was described as being inflat ed ''after'' reaching a wedge position. Considering this fact, cathete r migration with perforation of a distal small artery was evident. Dis tal migration is more frequently associated with rupture of the pulmon ary artery. In the third case we found a sequence of intimal lesions i n the right main pulmonary artery and a segmental artery of the right lung. This high number of PAC-induced lesions is unusual and suggests inappropriate inflation technique. Conclusions, Based on our observati ons, we believe the low complication rate associated with PAC insertio n has led to deviations from the normal guidelines by some physicians. Despite adequate precautions and insertion technique, iatrogenic lesi ons cannot be avoided in all cases because of pre-existing risk factor s. For the evaluation of catheter-induced complications and the develo pment of a risk profile, more autopsies as well as more detailed clini cal documentation would be necessary.