The risk of a major complication of pulmonary arterial catheterisation developing at some time during the monitoring period has been estimated at up to 10%. For this reason, it is essential that PAC monitoring not be undertaken lightly and that the technique only be used when there is a clearly perceived patient benefit (See Risk:Benefit Analysis.). It should also be remembered that of the alternatives to the PAC, central venous cannulation entails many of the same risks which are incurred when a PAC is used.

The prevention of the complications of central venous cannulation has recently been comprehensively reviewed by McGee and Gould in the New England Journal of Medicine ³. They noted that in the United States, physicians insert more than 5 million central venous catheters every year. They classified the complications of cannulation as 'Mechanical', 'Infectious' or 'Thrombotic' and after reviewing the literature, they concluded that more than 15 percent of patients who received these catheters would develop some form of complication. In particular, they reported the risk of a mechanical complication occurring as 5 to 19 percent, an infectious complication as 5 to 26 percent, and a thrombotic complications as 2 to 26 percent.

In comparison to central venous pressure monitoring, the principal specific risks of the PAC are conduction block, pulmonary infarction and pulmonary artery rupture ¹. Provided that proper precautions are taken, most of these complications can be avoided.

Risks related to venepuncture.
The major risks of venepuncture are comparable whether central venous or pulmonary arterial catheterisation is being undertaken. Inadvertent arterial puncture and pneumothorax constitute the most important hazards and are discussed in detail in the sections on the complications of internal jugular venepuncture and the complications of subclavian venepuncture. Other complications are outlined in section entitled 'Miscellaneous complications'.

Risks related to the passage of a 'J' wire.
The most common complication of the passage of a 'J' wire is the induction of cardiac arrhythmias. Other complications include vascular perforation, fragmentation of the wire and entrapment of the wire in another intravascular device such as a Greenfield filter ².

Risks related to the passage of the catheter through the heart.
The major risk of passage is of cardiac arrhythmias. This is discussed in that section.

Risks related to the presence of the catheter in the pulmonary artery.
The important 'acute' risks include pulmonary infarction and arterial rupture. These risks can be greatly reduced if an appropriate set of guidelines for safe usage is observed. The most important 'chronic' risk is that of catheter-related sepsis. Other complications are outlined in section entitled 'Miscellaneous complications'.

1. Roizen MF, Berger DL, Gabel RA et al Practice Guidelines for pulmonary artery catheterization. A report by the American Society of Anesthesiologists task force on pulmonary artery catheterization. Anesthesiology 78:380-394, 1993

2. Andrews RT, Geschwind JF, Savader SJ, Venbrux AC Entrapment of J-tip guidewires by Venatech and stainless-steel Greenfield vena cava filters during central venous catheter placement: percutaneous management in four patients. Cardiovasc Intervent Radiol 1998 Sep-Oct;21(5):424-8

3. McGee DC, Gould MK. Preventing complications of central venous catheterization. N Engl J Med. 2003 Mar 20;348(12):1123-33.

Last edited on: 29/03/2003