Pulmonary Artery Catheterization

What is pulmonary artery catheterization?

Pulmonary artery catheterization is a procedure using a long, thin tube (catheter) inserted into a pulmonary artery. It can help diagnose and manage many health problems.

The pulmonary artery is the main artery coming from the right ventricle of the heart. This lower chamber of the heart contains blood that's low in oxygen. The pulmonary artery carries this blood to the lungs. There, the blood picks up more oxygen and releases carbon dioxide.

Pulmonary artery catheterization uses a catheter that has an inflatable balloon at its tip. The healthcare provider puts this tube through a large vein. The tube is then moved to the right atrium, one of the heart’s upper chambers. It's then moved on through the right ventricle and out through a pulmonary artery. The provider then inflates the balloon and wedges it into a small branch of the pulmonary artery. With the catheter in place, the provider can learn more about pressure in the right side of the heart and in the arteries of the lungs. Blood samples can also be taken at various sites in the heart to understand blood oxygen flow. The procedure can also tell other important details, such as heart output. The findings can help in treating many health conditions.

This procedure can be done at the bedside in the intensive care unit (ICU). It can also be done in the operating room during open-heart surgery or in the cardiac cath lab. The measurement catheter may be used to take a quick measurement. Or it may be left in place for longer monitoring.

Why might I need pulmonary artery catheterization?

Some people in the ICU will need this procedure if they are critically ill. Healthcare providers also may do it as part of a cardiac catheterization procedure. They use it to help diagnose many health problems. These include:

• Shock

• Fluid buildup in the lungs (pulmonary edema)

• Heart failure

• Congenital heart disease

• High blood pressure in the lungs (pulmonary hypertension)

Pulmonary artery catheterization can help guide treatment. It can also help your provide know how serious your illness is. For example, it can help with:

• Complex heart attacks

• Being unstable before or after surgery

• High blood pressure near the end of pregnancy (severe preeclampsia)

• Medicine therapy

• Fluid levels in the blood vessels

• Burns

• Kidney failure

• Heart failure

• Sepsis

• Ventilator management

What are the risks of pulmonary artery catheterization?

Complications are rare with pulmonary artery catheterization. But it does have risks. Risk factors vary based on your overall health and any other health problems you have. Ask your healthcare provider about your specific risks. Possible risks include:

• Abnormal heart rhythms, some of which can be life-threatening

• Right bundle branch block, which is often short-term (temporary)

• The catheter gets knotted

• The pulmonary artery bursts open (ruptures)

• Severely reduced blood flow to part of the lung

• Blood clots which can damage the lung

• Heart valve infection (endocarditis)

• Catheter infections

• Bleeding at the insertion site

There is also a risk of inaccurate catheter placement. If this happens, the device can give incorrect information. That can affect treatment.

Healthcare providers always weigh the benefits and risks of the procedure for certain people. Risks may be higher for some people. These include older adults and people who have higher pressure in the vessels of the lungs.

How do I get ready for pulmonary artery catheterization?

Ask your healthcare provider how to get ready for this procedure. Follow any directions you're given about not eating or drinking before the procedure. You may also need to stop taking certain medicines, as directed by your healthcare provider.

Your healthcare provider may want some other tests before the procedure. These might include:

• Chest X-ray

• Electrocardiogram (ECG), to look at heart rhythm

• Blood tests, to check general health

• Echocardiogram, to see blood flow through the heart and to view the fluid around the heart

Talk with your healthcare team about any allergies that you may have to sedatives, numbing medicines, skin glues, or skin preparations before you have this procedure.

What happens during a pulmonary artery catheterization?

Talk with your healthcare provider about exactly what will happen. A provider and a special team of nurses will do the procedure. It may take place at the bedside in an ICU. Or it may be done in a special catheterization lab. In general:

• You'll be awake. You may be given medicine to make you sleepy before the procedure starts.

• Your vital signs will be closely watched. Healthcare providers will be prepared to step in if problems happen.

• Your healthcare provider will select the blood vessel where they'll insert the catheter. That might be in the arm, in the neck, in the groin, or below the collarbone.

• The provider injects a numbing medicine under the skin at the site where the catheter will be inserted.

• The provider uses a special needle to enter the blood vessel. They'll put a wire into this vessel.

• The provider puts a catheter over this wire, and then removes the wire.

• The provider moves a smaller catheter with a balloon at its tip through the blood vessel. They'll use the first tube as a guide.

• The provider moves the catheter to the right atrium. They then inflate the balloon at the tip. The provider will move the tube farther through the right ventricle and then out through a pulmonary artery to a smaller vessel.

• The provider may use X-ray images to carefully watch the catheter.

• Once the tube is in position, it will be fastened to the skin with tape or stitches (sutures), so it can’t move.

What happens after a pulmonary artery catheterization?

Ask your healthcare provider about what to expect after the procedure. In general:

• You may be groggy and disoriented.

• Your vital signs will be closely watched. These include your heart rate, blood pressure, breathing, and oxygen levels.

• You'll need a chest X-ray to confirm the position of the catheter. You may need daily X-rays as long as you have the tube.

• Most people who have pulmonary artery catheterization are very ill. These people may need to stay in the hospital for at least several days.

• If the tube is needed for more than a few days, it will be removed. A new one will be put in a different site to help prevent infection.

• Once the catheter is no longer needed, it will be removed.

After you leave the hospital:

• Don’t do vigorous exercise until your healthcare provider says you're ready. Much of your recovery will depend on why you had the procedure.

• Keep all your follow-up visits with your provider.

• Call your provider if you have a fever, increased draining from where the needle was inserted, chest pain, or any severe symptoms.

• Follow all your provider’s instructions on medicine, exercise, diet, and wound care.

Next steps

Before you agree to the test or the procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would  happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure