An excellent set of guidelines for the safe use of pulmonary artery catheters has been proposed by Thomas and Kramer in their book "Manual of Cardiac Anesthesia" ¹. Their guidelines are:

1. Balance risk versus benefit.

2. Slowly inflate balloon while continuously monitoring the pulmonary artery waveform.

3. Upon transition from the pulmonary artery to PAOP trace, immediately stop inflation.

4. If an overwedge pattern is observed, immediately deflate the balloon and withdraw the catheter 1-2 cm. Slowly reinflate the balloon; a normal wedge pressure waveform should be noted.

5. Minimize duration of PAOP measurements.

6. If balloon inflates with less than 1.5 cc of gas, withdraw the catheter at least 1-2 cm.

7. Spontaneous tip migration may occur; therefore continuously monitor the PA trace for 'spontaneous wedging'. If this occurs, withdraw the catheter 1-2 cm or until a normal PA tracing reappears.

8. Minimize number of PAOP measurements in patients who are elderly, have received anticoagulants or have pulmonary hypertension.

9. If pulmonary artery diastolic pressure is less than 18 mm Hg, use PAEDP rather than PAOP as the index of left ventricular filling pressure.

1. Thomas SJ & Kramer JL. Manual of Cardiac Anesthesia. Churchill Livingstone.

Last edited on: 13/11/2000