Shearing of a Pulmonary Artery Introducer Venous Sheath and Successful Surgical Retrieval: A Case Report
Year: 2025
Type: article
Study design: Case Report
Abstract: a kink, we pulled the PA sheath slightly, but to our surprise, it suddenly gave way and the sheath was inadvertently severed.We found that only a portion of it could be pulled out (Fig. 1). IntroductIonInsertion of a central venous catheter (CVC) and pulmonary artery (PA) introducer sheath is performed in cardiac surgery for several reasons, including the need for initiation of inotropes, monitoring of central venous and PA pressure, blood sampling, and cardiac output determination/monitoring.However, the use of a CVC/ pulmonary artery catheter (PAC) introducer sheath is not without complications. 1 Mechanical complications such as catheter fracture and migration 2-5 rarely occur, with an incidence of 0.1%.6 Accidental embolization of part of a CVC is very uncommon but a significant concern.We report an unusual fracture of a PA introducer venous sheath, which was retrieved surgically. case descrIptIonA 66-year-old male presented in the emergency department with a history of angina on exertion for the last 3 months.An electrocardiogram (ECG) revealed ST abnormalities.He underwent a coronary angiography, which showed three-vessel coronary artery disease.After conducting all the routine preoperative investigations, he was scheduled for a minimally invasive coronary artery bypass graft surgery.In the operating room, standard American Society of Anesthesiologists (ASA) monitors were placed.A broad-gauge peripheral line (16G) and a right radial arterial line (20G) were secured.Since the patient had severe left ventricular dysfunction, under ultrasound guidance, two guidewires (one for a CVC and another for a PA introducer sheath) were inserted in the right internal jugular vein under local anesthesia.A 7.5F, 15 cm long CVC was passed over one of the guidewires using the Seldinger technique.Thereafter, a PA introducer central venous sheath (9 Fr, Safety Wedge™ PAC sheath, Biosensors International) was railroaded down.The other guidewire was used to introduce a triple-lumen CVC.Though the ultrasound confirmed a correct puncture and guidewire position, we didn't get a free aspirate from the side port of the PA introducer sheath.The ultrasound revealed the sheath to be inside the vein.Even at this juncture, the guidewire glided smoothly through the sheath.Assuming
Source: Journal of Acute Care
Language: English
Subfield: Emergency Medical Services
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W4413405963