A 60-year-old female patient underwent emergency cadaveric liver transplantation. During the insertion of the pulmonary artery catheter (PAC) through the left innominate vein, advancement of the catheter was not successful and a knot occurred. An interventional radiologist performed antegrade rigid wire insertion into the PAC and succeeded in loosening the knot in the vessel. We report the successful removal of a knot through intervention without additional invasive procedures in a hemodynamically unstable patient with a coagulopathy.
SwanHJGanzWForresterJMarcusHDiamondGChonetteD. Catheterization of the heart in man with use of a flow-directed balloon-tipped catheter. N Engl J Med. 1970;283(9):447–451.
2.
KelsoLA. Complications associated with pulmonary artery catheterization. New Horiz. 1997;5(3):259–263.
3.
SlungHBScherKS. Complications of the Swan-Ganz catheter. World J Surg. 1984;8(1):76–81.
4.
BossertTGummertJFBittnerHB. Swan-Ganz catheter-induced severe complications in cardiac surgery: right ventricular perforation, knotting, and rupture of a pulmonary artery. J Card Surg. 2006;21(3):292–295.
5.
de Jesus PeixotoCamargo JMarcantonio CamargoSNoguchi MachucaTWagnerP. Intraoperative removal of a knotted Swan-Ganz catheter during lung transplantation. Interact Cardiovasc Thorac Surg. 2008;7(5):861–862.
6.
EshkevariLBakerBM. Occurrence and removal of a knotted pulmonary artery catheter: a case report. AANA J. 2007;75(6):423–428.
7.
IshaqMAlexanderNScottDH. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus. Saudi J Anaesth. 2013;7(2):191–193.
8.
Valenzuela-GarciaLFAlmendro-DeliaMGonzalez-ValdayoM. Percutaneous retrieval of a pulmonary artery catheter knot in pacing electrodes. Cardiovasc Intervent Radiol. 2007;30(5):1082–1084.
9.
BoydKDThomasSJGoldJBoydAD. A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest. 1983;84(3):245–249.
10.
KaranikasIDPolychronidisAVrachatisAArvanitisDPSimopoulosCELazaridesMK. Removal of knotted intravascular devices. Case report and review of the literature. Eur J Vasc Endovasc Surg. 2002;23(3):189–194.
11.
ColbertSO’HanlonDMQuillDSKeaneP. Swan Ganz catheter—all in a knot. Eur J Anaesthesiol. 1997;14(5):518–520.
GeorghiouGPVidneBARaananiE. Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution. Heart. 2004;90(5):e28.
14.
PikwerABaathLDavidsonBPerstoftIAkesonJ. The incidence and risk of central venous catheter malpositioning: a prospective cohort study in 1619 patients. Anaesth Intensive Care. 2008;36(1):30–37.
15.
ParkJHSimKCLeeSHwangGS. Unusual venous route of pulmonary artery catheter in a liver transplant recipient: pericardiophrenic or highest intercostal vein? A case report. Korean J Anesthesiol. 2014;67(1):57–60.
