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Review
. 2022 Feb;36(1):5-15.
doi: 10.1007/s10877-021-00662-8. Epub 2021 Feb 10.

The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

I T Bootsma  1 , E C Boerma  2 , F de Lange  2 , T W L Scheeren  3
Affiliations
Review

The contemporary pulmonary artery catheter. Part 1: placement and waveform analysis

I T Bootsma et al. J Clin Monit Comput. 2022 Feb.

Abstract

Nowadays, the classical pulmonary artery catheter (PAC) has an almost 50-year-old history of its clinical use for hemodynamic monitoring. In recent years, the PAC evolved from a device that enabled intermittent cardiac output measurements in combination with static pressures to a monitoring tool that provides continuous data on cardiac output, oxygen supply and-demand balance, as well as right ventricular (RV) performance. In this review, which consists of two parts, we will introduce the difference between intermittent pulmonary artery thermodilution using cold bolus injections, and the contemporary PAC enabling continuous measurements by using a thermal filament which at random heats up the blood. In this first part, the insertion techniques, interpretation of waveforms of the PAC, the interaction of waveforms with the respiratory cycle and airway pressure as well as pitfalls in waveform analysis are discussed. The second part will cover the measurements of the contemporary PAC including measurement of continuous cardiac output, RV ejection fraction, end-diastolic volume index, and mixed venous oxygen saturation. Limitations of all of these measurements will be highlighted there as well. We conclude that thorough understanding of measurements obtained from the PAC are the first step in successful application of the PAC in daily clinical practice.

Keywords: Hemodynamic monitoring; Pulmonary artery catheter; Pulmonary artery pressure; Waveform characteristics.

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Conflict of interest statement

ITB, ECB, and FdL do hereby declare that there are no conflict of interest. TWLS received research Grants and honoraria from Edwards Lifesciences (Irvine, CA, USA) and Masimo Inc. (Irvine, CA, USA) for consulting and lecturing and from Pulsion Medical Systems SE (Feldkirchen, Germany) for lecturing. TWLS is editor in chief of the Journal of Clinical Monitoring and Computing but had no role in the handling of this manuscript.

Figures

Fig. 1
Fig. 1
Placement of the PAC guided by the characteristics of normal vascular pressures and waveforms . *For placement in the left internal jugular vein or left subclavian vein one should add 5 cm to each of the landmarks . CVP central venous pressure, PAC pulmonary artery catheter, PAP pulmonary artery pressure, RVP right ventricular pressure
Fig. 2
Fig. 2
Pressure waveform pitfalls and abnormalities . CA cannon a-wave, CVP central venous pressure, ECG electrocardiogram, RV right ventricle, RVP right ventricular pressure, PAP pulmonary artery pressure, ART arterial
Fig. 3
Fig. 3
Pulmonary artery catheter location in relationship to West`s zones of the lung Pap pulmonary arterial pressure, Pa pressure in the alveoli, Ppv pulmonary venous pressure
See this image and copyright information in PMC

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