Surgical Removal of a Knotted Intravascular Pulmonary Artery Catheter

A pulmonary artery (PA) catheter was placed in a 60-year-old patient with congestive heart failure, undergoing lumbar spinal surgery. In the prone position, no wedge pressure wave could be obtained, and multiple attempts at repositioning were unsuccessful. Fluoroscopy showed a catheter knot in the right internal jugular vein, which was removed surgically through the original venotomy site. The knot was thought to be caused by excessive manipulation at too great an insertion depth, with low cardiac output. We conclude it is important to follow the guidelines for PA catheter placement, using step-wise gentle manual attempts. If knotted, radiological interventions and surgical extrication must be considered.