Entrapment of a pulmonary artery catheter inside a knotted percutaneous sheath introducer

Excerpt

An 82-yr-old male (who consented to this report) was scheduled to undergo aortic valve replacement for aortic stenosis and coronary artery bypass surgery. After induction of general anesthesia, an 8.5 Fr percutaneous sheath introducer (Arrow International, PA, USA) was inserted into the right internal jugular vein under ultrasound guidance. A 7.5 Fr pulmonary artery catheter (PAC) (Biosensors International, Singapore) was then threaded through the sheath to 54 cm without difficulty and without wedging. A routine postoperative chest x-ray showed what appeared to be a semi-loop of the PAC in the right ventricle with the distal tip in the main pulmonary artery. On postoperative day 1, resistance was encountered on removal of the PAC, and a subsequent chest x-ray confirmed a knot at the distal end of the introducer sheath (Figure). As a result, the introducer sheath and PAC were removed via a transverse jugular venotomy under general anesthesia, and the patient was discharged home on postoperative day 5 without further complications.

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